Provider Demographics
NPI:1346319506
Name:BARNES, DAVID RANDALL (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDALL
Last Name:BARNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3911
Mailing Address - Country:US
Mailing Address - Phone:731-424-6500
Mailing Address - Fax:731-427-3687
Practice Address - Street 1:609 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-424-6500
Practice Address - Fax:731-427-3687
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice