Provider Demographics
NPI:1750517462
Name:BARNARD, PETER ROY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROY
Last Name:BARNARD
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 1:821 SE OCEAN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2456
Mailing Address - Country:US
Mailing Address - Phone:772-283-4427
Mailing Address - Fax:
Practice Address - Street 1:821 SE OCEAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2456
Practice Address - Country:US
Practice Address - Phone:772-283-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice