MEDICARE: DEREK C BARNES DMD PA

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	7104	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578770624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK C BARNES DMD PA

Provider Business Mailing Address
First Line	:	1422 ORCHARD LAKE DR # A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1474
Country	:	US
Telephone Number	:	704-849-6700
Fax Number	:	704-849-6874

Provider Business Practice Location Address
First Line	:	1422 ORCHARD LAKE DR # A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1474
Country	:	US
Telephone Number	:	704-849-6700
Fax Number	:	704-849-6874

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DEREK C BARNES
Credential	:	D.M.D
Telephone Number	:	704-849-6700

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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