MEDICARE: OAK FOREST DENTAL GROUP AND ORTHODONTICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1033461223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK FOREST DENTAL GROUP AND ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	1354 W 43RD ST STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-4206
Country	:	US
Telephone Number	:	713-263-7913
Fax Number	:	713-263-7503

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN S BARNES
Credential	:	DDS
Telephone Number	:	713-263-7913

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	12/31/2013

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