Healthcare Provider Details

I. General information

NPI: 1215150842
Provider Name (Legal Business Name): SPENCER P BARNES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/17/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDOW RUN DR. SUITE 2
HASTINGS MI
49058
US

IV. Provider business mailing address

300 MEDOW RUN DR. SUITE 2
HASTINGS MI
49058
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8500
  • Fax: 269-592-5969
Mailing address:
  • Phone: 269-948-8500
  • Fax: 269-592-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018827
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: