Provider Demographics
NPI:1124333497
Name:BARNES DENTAL CORPORATION INC
Entity type:Organization
Organization Name:BARNES DENTAL CORPORATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST DDS
Authorized Official - Phone:559-635-0206
Mailing Address - Street 1:2626 S. MOONEY BLVD. SUITE C
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-635-0206
Mailing Address - Fax:559-635-0211
Practice Address - Street 1:2626 S. MOONEY BLVD, SUITE C
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-635-0206
Practice Address - Fax:559-635-0211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARNES DENTAL SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-11
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38644122300000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6372840001Medicare PIN