MEDICARE: DR. BRUCE W BARNES D.D.S.

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	1223G0001X	General Practice Dentistry	5927	CO

General Provider Information

NPI Number	:	1588775084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE W BARNES D.D.S.

Provider Business Mailing Address
First Line	:	1424 N HANCOCK AVE STE 2W
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2671
Country	:	US
Telephone Number	:	719-636-1246
Fax Number	:	719-375-8879

Provider Business Practice Location Address
First Line	:	1424 N HANCOCK AVE STE 2W
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2671
Country	:	US
Telephone Number	:	719-636-1246
Fax Number	:	719-375-8879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/29/2015

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