Provider Demographics
NPI:1811026164
Name:BARNES, DAN TERRY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:TERRY
Last Name:BARNES
Suffix:JR
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:PO BOX 930
Mailing Address - Street 2:110 SW SUWANNEE AVENUE
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-0930
Mailing Address - Country:US
Mailing Address - Phone:386-935-0988
Mailing Address - Fax:386-935-0989
Practice Address - Street 1:110 SUWANNEE AVE SW
Practice Address - Street 2:110 SW SUWANNEE AVENUE
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-2749
Practice Address - Country:US
Practice Address - Phone:386-935-0988
Practice Address - Fax:386-935-0989
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 108741223G0001X
AKDN 10401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD 4603Medicaid