Provider Demographics
NPI:1578457842
Name:BARRACK, ADAM (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BARRACK
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 1:37459 ULTIMA PLAZA BLVD # B224
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3856
Mailing Address - Country:US
Mailing Address - Phone:225-317-5379
Mailing Address - Fax:
Practice Address - Street 1:4400 EMILE ST # 3602
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0600
Practice Address - Country:US
Practice Address - Phone:402-559-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist