Provider Demographics
NPI:1013115146
Name:BARNES, MIA JUANIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:JUANIQUE
Last Name:BARNES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 CHADBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3231
Mailing Address - Country:US
Mailing Address - Phone:504-427-6682
Mailing Address - Fax:
Practice Address - Street 1:3600 PRYTANIA ST
Practice Address - Street 2:SUITE NUMBER 50
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3628
Practice Address - Country:US
Practice Address - Phone:504-891-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1856835Medicaid