Healthcare Provider Details

I. General information

NPI: 1033310461
Provider Name (Legal Business Name): AMOS MICHAEL BARNES D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 S HARRISON ST
ORANGE NJ
07050-3115
US

IV. Provider business mailing address

462 S HARRISON ST
ORANGE NJ
07050-3115
US

V. Phone/Fax

Practice location:
  • Phone: 973-395-9151
  • Fax:
Mailing address:
  • Phone: 973-395-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01589000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01589000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: