Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5530 | WI |
NPI | 1073652608 |
---|---|
Provider Name | Dr. Douglas Barden |
First Address | Milwaukee, WI 53217 |
Second Address | Milwaukee, WI 53217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 09/01/2014 |