Provider Demographics
NPI:1538477484
Name:BARNES AND MCDONNELL PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BARNES AND MCDONNELL PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-760-0550
Mailing Address - Street 1:1440 REED CANAL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-9418
Mailing Address - Country:US
Mailing Address - Phone:386-760-0550
Mailing Address - Fax:386-756-1009
Practice Address - Street 1:1440 REED CANAL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9418
Practice Address - Country:US
Practice Address - Phone:386-760-0550
Practice Address - Fax:386-756-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty