Provider Demographics
NPI:1861561508
Name:BARKER, DALE RONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:RONALD
Last Name:BARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 SE DOUGLAS PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6108
Mailing Address - Country:US
Mailing Address - Phone:503-492-2605
Mailing Address - Fax:
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:SUITE 265
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-665-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD59351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics