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General NPI Number Information
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NPI Number | 1326360397
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Entity Type | Organization
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Legal Business Name | LAYNE & BARTH FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 19606 SR 20 W
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-4007
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Country | US
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Telephone | 850-674-5502
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Fax | 850-674-9790
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Provider Business Mailing Address
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Address Line | 19606 SR 20 W.
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424
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Country | US
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Telephone | 850-674-8681
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Fax | 850-674-9790
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BARBARA H. COLLIER
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Credential |
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Telephone | 850-674-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN6876
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18715
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License Number State | FL
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