Jacklyn Barlage, DMD
Individual provider Active NPI General Practice Dentistry · Minot Afb, ND
NPI 1700587409 · NPPES record last updated Nov 13, 2025
Key facts
- NPI
- 1700587409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 30.027269 (OH)
- Practice address
- 10 Missile Ave
Minot Afb, ND 58705-5003 - Phone
- (701) 723-5565
- NPI assigned
- Mar 10, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.027269 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30.027269 | OH | Yes |
Addresses
Primary practice location
10 Missile Ave
Minot Afb, ND 58705-5003
Mailing address
10 Missile Ave
Minot Afb, ND 58705-5003
Other providers in Minot Afb, ND
- Folashade Ajulo
- Kirsten Noel Anders
- Kasumi Anderson
- Jennifer Arnholtz
- Ramil Agana Ascano
- Victor Beals
- David Joseph Bergstrom
- Karrie Ann Bissen
- Raymond Roger Bouchard
- Erin Lynn Bradford
All providers in Minot Afb, ND · General Practice Dentistry in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.