Basic Information
| Provider Information | |||||||||
| NPI: | 1003804279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARBER | ||||||||
| FirstName: | HARGROW | ||||||||
| MiddleName: | DEXTER | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6601 S RURAL RD | ||||||||
| Address2: | SOUTHWEST DENTAL GROUP | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852833747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804560821 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E LEHIGH AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191251000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157073613 | ||||||||
| FaxNumber: | 2157075405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 07/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DS027665L | PA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 22DI020061 | NJ | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5530504 | 05 | NJ | MEDICAID |