Provider Demographics
NPI:1568194900
Name:BARNES, SHYANNE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHYANNE
Middle Name:MARIE
Last Name:BARNES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GREENBRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6442
Mailing Address - Country:US
Mailing Address - Phone:207-550-7037
Mailing Address - Fax:
Practice Address - Street 1:1 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2240
Practice Address - Country:US
Practice Address - Phone:207-760-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist