Individual
DR. MARTIN THOMAS BARCO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 N WALNUT ST, BLOOMINGTON, IN 47404-3811
(812) 332-8290
Mailing address
1050 WISHARD BLVD # R4201, DEPARTMENT OF ORAL SURGERY AND HOSPITAL DENTISTRY IUPUI, INDIANAPOLIS, IN 46202-2872
(317) 312-0890
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
120011246A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200978410
—
IN
Enumeration date
10/22/2007
Last updated
02/27/2018
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