Provider Demographics
NPI:1871501064
Name:BARNES, BLAKE EVERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:EVERS
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 1:2800 4TH ST SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1596
Mailing Address - Country:US
Mailing Address - Phone:641-424-8062
Mailing Address - Fax:641-421-7622
Practice Address - Street 1:2800 4TH ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1596
Practice Address - Country:US
Practice Address - Phone:641-424-8062
Practice Address - Fax:641-421-7622
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0500116Medicaid