Provider Demographics
NPI:1669738902
Name:TAE HJ BARTO DDS
Entity type:Organization
Organization Name:TAE HJ BARTO DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-783-5564
Mailing Address - Street 1:6057 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1704
Mailing Address - Country:US
Mailing Address - Phone:515-285-4759
Mailing Address - Fax:515-287-2948
Practice Address - Street 1:6057 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1704
Practice Address - Country:US
Practice Address - Phone:515-285-4759
Practice Address - Fax:515-287-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty