MEDICARE: DAVID RANDALL BARNES DDS

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	8376	TN

General Provider Information

NPI Number	:	1346319506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RANDALL BARNES DDS

Provider Business Mailing Address
First Line	:	609 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-424-6500
Fax Number	:	731-427-3687

Provider Business Practice Location Address
First Line	:	609 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-424-6500
Fax Number	:	731-427-3687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/15/2016

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