Provider Demographics
NPI:1750655627
Name:BARNES, JONATHAN BRUCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRUCE
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 1:1630 S STAPLEY DR STE 208
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6659
Mailing Address - Country:US
Mailing Address - Phone:480-775-2656
Mailing Address - Fax:
Practice Address - Street 1:1630 S STAPLEY DR STE 208
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6659
Practice Address - Country:US
Practice Address - Phone:480-775-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0090641223E0200X
UT8350105-99211223G0001X
390200000X
AZD90641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program