Provider Demographics
NPI:1801806641
Name:BARLOW, MCKAY D (DDS)
Entity type:Individual
Prefix:DR
First Name:MCKAY
Middle Name:D
Last Name:BARLOW
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 1:143 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2332
Mailing Address - Country:US
Mailing Address - Phone:208-324-7007
Mailing Address - Fax:208-324-7540
Practice Address - Street 1:143 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2332
Practice Address - Country:US
Practice Address - Phone:208-324-7007
Practice Address - Fax:208-324-7540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-37591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice