Provider Demographics
NPI:1568537397
Name:BARNES, ROLAND JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:JOHN
Last Name:BARNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 CHARNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9693
Mailing Address - Country:US
Mailing Address - Phone:815-344-9118
Mailing Address - Fax:815-344-3329
Practice Address - Street 1:3700 IL ROUTE 173
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071-9614
Practice Address - Country:US
Practice Address - Phone:815-678-7751
Practice Address - Fax:815-678-6062
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice