Provider Demographics
NPI:1780187674
Name:MARTIN T BARCO, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARTIN T BARCO, D.D.S., P.C.
Other - Org Name:BARCO FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARCO
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:754-346-1481
Mailing Address - Street 1:615 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3811
Mailing Address - Country:US
Mailing Address - Phone:812-332-8290
Mailing Address - Fax:
Practice Address - Street 1:615 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3811
Practice Address - Country:US
Practice Address - Phone:812-332-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011246A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental