Provider Demographics
NPI:1215251673
Name:BARNES FAMILY DENTISTRY
Entity type:Organization
Organization Name:BARNES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLETTA
Authorized Official - Middle Name:YALONDA
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-545-7055
Mailing Address - Street 1:5910 HWY 49 STE
Mailing Address - Street 2:
Mailing Address - City:HATTIEBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-545-7055
Mailing Address - Fax:
Practice Address - Street 1:5910 HIGHWAY 49
Practice Address - Street 2:STE 15
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7585
Practice Address - Country:US
Practice Address - Phone:601-545-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3248-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09823388Medicaid