Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI020061 | NJ |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS027665L | PA |
NPI | 1003804279 |
---|---|
Provider Name | Hargrow Dexter Barber |
First Address | Tempe, AZ 85283-3747 |
Second Address | Philadelphia, PA 19125-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 20/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5530504 | (05) | NJ |
T96937 | (02) | PA |