Basic Information
| Provider Information | |||||||||
| NPI: | 1124253505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNO | ||||||||
| FirstName: | MICHEAL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 HOFF ST BLDG 9240 | ||||||||
| Address2: | USA DENTAL ACTIVITY | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441939 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 HOFF ST BLDG 9240 | ||||||||
| Address2: | USA DENTAL ACTIVITY | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2009 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 4456 | SC | Y | Dental Providers | Dentist |
No ID Information.