Provider Demographics
NPI:1215009204
Name:BARNES, B. TIM (DMD)
Entity Type:Individual
Prefix:
First Name:B.
Middle Name:TIM
Last Name:BARNES
Suffix:
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 1:901 N CARBON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1056
Mailing Address - Country:US
Mailing Address - Phone:618-993-3775
Mailing Address - Fax:618-993-8302
Practice Address - Street 1:901 N CARBON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1056
Practice Address - Country:US
Practice Address - Phone:618-993-3775
Practice Address - Fax:618-993-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice