Healthcare Provider Details

I. General information

NPI: 1184174039
Provider Name (Legal Business Name): CROSS ROADS SMILES DENTISTRY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 US HWY 380 SUITE 100
CROSS ROADS TX
76227
US

IV. Provider business mailing address

17000 RED HILL AVE
IRVINE CA
92614-5626
US

V. Phone/Fax

Practice location:
  • Phone: 940-205-4293
  • Fax: 940-228-4385
Mailing address:
  • Phone: 714-845-8890
  • Fax: 949-474-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN S BARNES
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 940-205-4293