Provider Demographics
NPI:1942755905
Name:BARTH FAMILY DENTISTRY P.S.C.
Entity Type:Organization
Organization Name:BARTH FAMILY DENTISTRY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BARTH OMOSIVWE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, RDH
Authorized Official - Phone:859-689-7700
Mailing Address - Street 1:1821 FLORENCE PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7942
Mailing Address - Country:US
Mailing Address - Phone:859-689-7700
Mailing Address - Fax:
Practice Address - Street 1:1821 FLORENCE PIKE STE 2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7942
Practice Address - Country:US
Practice Address - Phone:859-689-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100214590Medicaid
KY1982704656OtherINDIVIDUAL NPI FOR CHARITY A. BARTH OMOSIVWE