Provider Demographics
NPI:1598104747
Name:BARNES, ADAM TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:TYLER
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 1:13408 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1292
Mailing Address - Country:US
Mailing Address - Phone:405-308-3999
Mailing Address - Fax:
Practice Address - Street 1:6826 US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-4486
Practice Address - Country:US
Practice Address - Phone:918-786-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist