Provider Demographics
NPI:1013075738
Name:BARNES, ROY BRUCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROY
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 1:1750 ALEXANDRIA DR
Mailing Address - Street 2:1
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3100
Mailing Address - Country:US
Mailing Address - Phone:859-277-1189
Mailing Address - Fax:859-276-2719
Practice Address - Street 1:1750 ALEXANDRIA DR
Practice Address - Street 2:1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3100
Practice Address - Country:US
Practice Address - Phone:859-277-1189
Practice Address - Fax:859-276-2719
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60057171Medicaid