Provider Demographics
NPI:1376301762
Name:R&J PEDS LLC
Entity Type:Organization
Organization Name:R&J PEDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-515-1177
Mailing Address - Street 1:1445 WATERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7445
Mailing Address - Country:US
Mailing Address - Phone:262-515-1177
Mailing Address - Fax:
Practice Address - Street 1:1200 TWO ISLAND CT UNIT C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7418
Practice Address - Country:US
Practice Address - Phone:843-974-1200
Practice Address - Fax:843-654-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255666863OtherNPI OF OTHER PROVIDER IN PRACTICE/ORGANIZATION