Clark Tobias Barco, D.D.S. – Periodontics

Key facts

NPI: 1710089792
Entity type: Individual (NPI type 1)
Primary specialty: Periodontics 1223P0300X
License: 12007214A (IN)
Practice address: 1481 W 10TH St
Rvamc, Dental Service (160)
Indianapolis, IN 46202-2803
Phone: (317) 988-2024
Fax: (317) 988-0245
NPI assigned: Sep 1, 2006
Sex: Male
Sole proprietor: No

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
12007214A	IN	MD	Periodontist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Periodontics	1223P0300X	12007214A	IN	Yes

Addresses

Primary practice location

1481 W 10TH St
Rvamc, Dental Service (160)
Indianapolis, IN 46202-2803

Mailing address

1481 W 10TH St
Rvamc, Dental Service (160)
Indianapolis, IN 46202-2803
Phone (317) 988-2024

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710089792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1481 W 10TH ST",
            "address_2": "RVAMC, DENTAL SERVICE (160)",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022803",
            "telephone_number": "317-988-2024",
            "fax_number": "317-988-0245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 W 10TH ST",
            "address_2": "RVAMC, DENTAL SERVICE (160)",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022803",
            "telephone_number": "317-988-2024",
            "fax_number": "317-988-0245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARCO",
        "first_name": "CLARK",
        "middle_name": "TOBIAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12007214A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

All providers in Indianapolis, IN · Periodontics in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.

Verify at the official NPI Registry.