Healthcare Provider Details

I. General information

NPI: 1164508586
Provider Name (Legal Business Name): KENNETH CRAIG BARNEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NORTH MARY STREET
HEDGESVILLE WV
25427
US

IV. Provider business mailing address

2136 MOUNTAIN LAKE RD
HEDGESVILLE WV
25427-3863
US

V. Phone/Fax

Practice location:
  • Phone: 304-754-8803
  • Fax: 304-754-8039
Mailing address:
  • Phone: 304-754-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2665
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: