Provider Demographics
NPI:1992364871
Name:BARTON, MICAH DANIELLE (DMD)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:DANIELLE
Last Name:BARTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 S FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3105
Mailing Address - Country:US
Mailing Address - Phone:417-293-7307
Mailing Address - Fax:
Practice Address - Street 1:804 N HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704-7301
Practice Address - Country:US
Practice Address - Phone:417-924-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190188011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019018801OtherMISSOURI PROFESSIONAL LICENSE