Provider Demographics
NPI:1558484881
Name:BARNES, JEFFRY DWIGHT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:DWIGHT
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 1:320 AVENUE K SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4147
Mailing Address - Country:US
Mailing Address - Phone:863-293-5099
Mailing Address - Fax:863-293-8970
Practice Address - Street 1:320 AVENUE K SE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4147
Practice Address - Country:US
Practice Address - Phone:863-293-5099
Practice Address - Fax:863-293-8970
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 126531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics