Organization Active NPI

Barry G Acker DDS PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Tyler, TX
National Provider Identifier
1124393434
Registry record updated Mar 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
8636 Issued in TX
Legal business name
BARRY G ACKER DDS PA
Practice address
3100 New Copeland Rd
Tyler, TX 75701-7940
Phone
(903) 597-2848
Fax
(903) 593-9626
NPI assigned
Mar 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barry G Acker
Title
President/Owner
Phone
(903) 597-2848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 8636 TX Primary

Addresses

Primary practice location

3100 New Copeland Rd
Tyler, TX 75701-7940

Mailing address

3100 New Copeland Rd
Tyler, TX 75701-7940
Phone (903) 597-2848

Other identifiers 4

IdentifierTypeStateIssuer
4521923OtherTXAETNA
120698902MedicaidTX
120698906MedicaidTX
844377OtherTXUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

3100 New Copeland Rd
Tyler, TX 75701
Phone (903) 597-2848

2550 Elkton Trl
Tyler, TX 75703
Phone (903) 534-1414

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332201600000",
    "number": "1124393434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 NEW COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757017940",
            "telephone_number": "903-597-2848",
            "fax_number": "903-593-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 NEW COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757017940",
            "telephone_number": "903-597-2848",
            "fax_number": "903-593-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY G ACKER DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2012-03-20",
        "status": "A",
        "authorized_official_last_name": "ACKER",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "903-597-2848"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "8636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4521923",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120698902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120698906",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "844377",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.