Provider Demographics
NPI:1326360397
Name:LAYNE & BARTH FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:LAYNE & BARTH FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-674-5502
Mailing Address - Street 1:19606 SR 20 W.
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424
Mailing Address - Country:US
Mailing Address - Phone:850-674-8681
Mailing Address - Fax:850-674-9790
Practice Address - Street 1:19606 SR 20 W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-4007
Practice Address - Country:US
Practice Address - Phone:850-674-5502
Practice Address - Fax:850-674-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN68761223G0001X
FLDN187151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL782-959OtherCOMP BENEFITS
FL782959OtherUNITED CONCORDIA
FL85486OtherBCBS