Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | M938 | SD |
NPI | 1225005473 |
---|---|
Provider Name | Dr. Brent L Barker |
First Address | Wanblee, SD 57577 |
Second Address | Wanblee, SD 57577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 08/07/2007 |