Healthcare Provider Details

I. General information

NPI: 1255782611
Provider Name (Legal Business Name): ASTIN VICTORIA BARNES DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 S BOYLAN AVE
RALEIGH NC
27603-2133
US

IV. Provider business mailing address

727 S BOYLAN AVE
RALEIGH NC
27603-2133
US

V. Phone/Fax

Practice location:
  • Phone: 252-230-7438
  • Fax:
Mailing address:
  • Phone: 252-230-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: