Provider Demographics
NPI:1063529337
Name:BARNEY, CHAD JOHN (DMD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JOHN
Last Name:BARNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3851
Mailing Address - Country:US
Mailing Address - Phone:208-798-8907
Mailing Address - Fax:
Practice Address - Street 1:328 SAINT JOHNS WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2451
Practice Address - Country:US
Practice Address - Phone:208-746-1771
Practice Address - Fax:208-798-1586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-31471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice