Provider Demographics
NPI:1083211924
Name:SPENCER P BARNES
Entity Type:Organization
Organization Name:SPENCER P BARNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-948-8500
Mailing Address - Street 1:300 MEADOW RUN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-9048
Mailing Address - Country:US
Mailing Address - Phone:269-948-8500
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOW RUN DR STE 2
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9048
Practice Address - Country:US
Practice Address - Phone:269-948-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty