Provider Demographics
NPI:1992816326
Name:BARNES, MARTIN MILLER JR (DMD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:MILLER
Last Name:BARNES
Suffix:JR
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 1:422 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6196
Mailing Address - Country:US
Mailing Address - Phone:256-764-6761
Mailing Address - Fax:256-767-2370
Practice Address - Street 1:422 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6196
Practice Address - Country:US
Practice Address - Phone:256-764-6761
Practice Address - Fax:256-767-2370
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice