Provider Demographics
NPI:1710089792
Name:BARCO, CLARK TOBIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:TOBIAS
Last Name:BARCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:RVAMC, DENTAL SERVICE (160)
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2024
Mailing Address - Fax:317-988-0245
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:RVAMC, DENTAL SERVICE (160)
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2024
Practice Address - Fax:317-988-0245
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007214A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics