Provider Demographics
NPI:1992884860
Name:BARNES, KELLY ANNE (DMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:BARNES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BOSTON POST RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2463
Mailing Address - Country:US
Mailing Address - Phone:978-443-7101
Mailing Address - Fax:
Practice Address - Street 1:111 BOSTON POST RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2463
Practice Address - Country:US
Practice Address - Phone:978-443-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics