MEDICARE: HULEN MODERN DENTISTRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1104132471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HULEN MODERN DENTISTRY, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	4833 S HULEN ST STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1427
Country	:	US
Telephone Number	:	817-294-4600
Fax Number	:	817-292-0077

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. JOHN S BARNES
Credential	:	DDS
Telephone Number	:	817-294-4600

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	01/02/2014

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