Provider Demographics
NPI:1265583843
Name:BARTON, MICHAEL WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:BARTON
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:GRAEAGLE
Mailing Address - State:CA
Mailing Address - Zip Code:96103-0399
Mailing Address - Country:US
Mailing Address - Phone:530-836-2223
Mailing Address - Fax:530-836-0842
Practice Address - Street 1:113 HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:GRAEAGLE
Practice Address - State:CA
Practice Address - Zip Code:96103-0399
Practice Address - Country:US
Practice Address - Phone:530-836-2223
Practice Address - Fax:530-836-0842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice