MEDICARE: DR. JERRY BARNES

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	122300000X	Dentist	6301	MN

General Provider Information

NPI Number	:	1740402932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JERRY BARNES

Provider Business Mailing Address
First Line	:	1871 OLD HUDSON RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:	651-738-0900
Fax Number	:	651-738-0902

Provider Business Practice Location Address
First Line	:	1871 OLD HUDSON RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:	651-738-0900
Fax Number	:	651-738-0902

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY E BARNES
Credential	:	D.D.S
Telephone Number	:	651-738-0900

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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