Provider Demographics
NPI:1215150842
Name:BARNES, SPENCER P (DDS)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:P
Last Name:BARNES
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 1:919 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4844
Mailing Address - Country:US
Mailing Address - Phone:517-485-5118
Mailing Address - Fax:517-485-2358
Practice Address - Street 1:919 CHESTER RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4844
Practice Address - Country:US
Practice Address - Phone:517-485-5118
Practice Address - Fax:517-485-2358
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice