=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942421896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIE RAY BARNES D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4986 NITTANY VALLEY DR. BOX 397
-----------------------------------------------------
City | LAMAR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-726-6748
-----------------------------------------------------
Fax | 570-726-6794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4986 NITTANY VALLEY DR. BOX 397
-----------------------------------------------------
City | LAMAR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-726-6748
-----------------------------------------------------
Fax | 570-726-6794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS026736L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------