Provider Demographics
NPI:1558390039
Name:BARNES, CHARLES L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
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:PO BOX 9
Mailing Address - Street 2:4 CHARLESTON PLZ
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-0009
Mailing Address - Country:US
Mailing Address - Phone:573-683-2122
Mailing Address - Fax:573-683-4174
Practice Address - Street 1:4 CHARLESTON PLZ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-4302
Practice Address - Country:US
Practice Address - Phone:573-683-2122
Practice Address - Fax:573-683-4174
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0150141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402714406Medicaid