Healthcare Provider Details

I. General information

NPI: 1811026164
Provider Name (Legal Business Name): DAN TERRY BARNES JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SUWANNEE AVE SW 110 SW SUWANNEE AVENUE
BRANFORD FL
32008-2749
US

IV. Provider business mailing address

PO BOX 930 110 SW SUWANNEE AVENUE
BRANFORD FL
32008-0930
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-0988
  • Fax: 386-935-0989
Mailing address:
  • Phone: 386-935-0988
  • Fax: 386-935-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 10874
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 1040
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: