Provider Demographics
NPI:1912058355
Name:BARLEY, JEFFREY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:BARLEY
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 1:25544 WILLOWBEND RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9707
Mailing Address - Country:US
Mailing Address - Phone:419-874-8655
Mailing Address - Fax:
Practice Address - Street 1:6904 SPRING VALLEY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8105
Practice Address - Country:US
Practice Address - Phone:419-865-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice