Provider Demographics
NPI:1144348178
Name:WIDDICOMBE, BARRY CRAIG (DDS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:CRAIG
Last Name:WIDDICOMBE
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 1:3804 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2648
Mailing Address - Country:US
Mailing Address - Phone:317-925-4202
Mailing Address - Fax:317-923-1507
Practice Address - Street 1:3804 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2648
Practice Address - Country:US
Practice Address - Phone:317-925-4202
Practice Address - Fax:317-923-1507
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN75371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice