Provider Demographics
NPI:1821194093
Name:BARTA, BRENT J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:BARTA
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 1:6443 W 10TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-6501
Mailing Address - Country:US
Mailing Address - Phone:317-247-9512
Mailing Address - Fax:317-484-6393
Practice Address - Street 1:6443 W 10TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-6501
Practice Address - Country:US
Practice Address - Phone:317-247-9512
Practice Address - Fax:317-484-6393
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351988754OtherTAX ID#