Healthcare Provider Details

I. General information

NPI: 1548557325
Provider Name (Legal Business Name): JOSEPH W BARNHART, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 HWY 63 S
VIENNA MO
65582-0999
US

IV. Provider business mailing address

PO BOX 999 1406 HWY 63 S
VIENNA MO
65582-0999
US

V. Phone/Fax

Practice location:
  • Phone: 573-422-3612
  • Fax: 573-422-3712
Mailing address:
  • Phone: 573-422-3612
  • Fax: 573-422-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011014522
License Number StateMO

VIII. Authorized Official

Name: DR. JOSEPH WILLIAM BARNHART
Title or Position: DENTIST
Credential: DDS
Phone: 573-422-3612