Provider Demographics
NPI:1184111403
Name:BARKAUSKAS, STACEY (DMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:BARKAUSKAS
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:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:WHITE DEER
Mailing Address - State:PA
Mailing Address - Zip Code:17887-2500
Mailing Address - Country:US
Mailing Address - Phone:570-547-7950
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 15, 2 MILES NORTH OF ALLENWOOD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810
Practice Address - Country:US
Practice Address - Phone:570-547-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382661223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health