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General NPI Number Information
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NPI Number | 1154827764
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Entity Type | Organization
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Legal Business Name | DENTISTS OF LAKE WORTH PC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 6532 LAKE WORTH BLVD
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City | LAKE WORTH
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State | TX
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Zip | 76135-3002
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Country | US
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Telephone | 817-778-0117
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Fax | 817-778-4041
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN S BARNES
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Credential |
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Telephone | 817-778-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12406
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License Number State | TX
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