Avis Lorraine Barker, D.M.D.
Individual provider Active NPI Dentist · Granger, IN
NPI 1003007352 · NPPES record last updated Mar 12, 2010
Key facts
- NPI
- 1003007352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12011066A (IN)
- Practice address
- 50648 Weeping Willow Run E
Granger, IN 46530-8750 - Phone
- (765) 532-7019
- NPI assigned
- Aug 1, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170109002653 | IN | Order and Referring Only - Dentist |
0547541450 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21957 | MA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21957 | MA | |
| Dentist | 122300000X | 12011066A | IN | Yes |
Addresses
Primary practice location
50648 Weeping Willow Run E
Granger, IN 46530-8750
Mailing address
50648 Weeping Willow Run E
Granger, IN 46530-8750
Phone (765) 532-7019
Other providers in Granger, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.