Basic Information
| Provider Information | |||||||||
| NPI: | 1508873720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 ARMY BLVD | ||||||||
| Address2: | APT A BLDG 2018 | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210835 | ||||||||
| FaxNumber: | 2102210824 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 ARMY BLVD | ||||||||
| Address2: | APT A BLDG 2018 | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210835 | ||||||||
| FaxNumber: | 2102210824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 43897 | CA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | BB9424209 | 01 | FEDERAL DEA | OTHER |