Healthcare Provider Details

I. General information

NPI: 1225442320
Provider Name (Legal Business Name): BARRON BANKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 SAN JOSE BLVD STE 64
JACKSONVILLE FL
32223-6671
US

IV. Provider business mailing address

10950 SAN JOSE BLVD STE 64
JACKSONVILLE FL
32223-6671
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 21320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: