Healthcare Provider Details

I. General information

NPI: 1679730790
Provider Name (Legal Business Name): ALYSON TERRY BARNES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18395 SW ALEXANDER ST
ALOHA OR
97003-3961
US

IV. Provider business mailing address

18395 SW ALEXANDER ST
ALOHA OR
97003-3961
US

V. Phone/Fax

Practice location:
  • Phone: 503-642-4552
  • Fax: 503-591-0202
Mailing address:
  • Phone: 503-642-4552
  • Fax: 503-591-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60632860
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18563
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 1855133
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD9829
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: