=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992001986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CEDAR HILL MODERN DENTISTRY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2011
-----------------------------------------------------
Last Update Date | 02/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 398 E FM 1382 STE B
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-6024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-291-6262
-----------------------------------------------------
Fax | 972-291-9981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2860 MICHELLE FL 2
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-368-2077
-----------------------------------------------------
Fax | 714-368-2092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DOCTOR
-----------------------------------------------------
Name | DR. JOHN S BARNES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 972-291-6262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------