Healthcare Provider Details

I. General information

NPI: 1811037633
Provider Name (Legal Business Name): DAVID LEROY BARNES SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CATHERINE STREET NORTH
ESTILL SC
29918-0547
US

IV. Provider business mailing address

PO BOX 547 144 CATHERINE ST NORTH
ESTILL SC
29918-0547
US

V. Phone/Fax

Practice location:
  • Phone: 803-625-3640
  • Fax:
Mailing address:
  • Phone: 803-625-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1572 SC
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: