Provider Demographics
NPI:1861402083
Name:BARNES, KATHY N (DDS,)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:N
Last Name:BARNES
Suffix:
Gender:F
Credentials:DDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5001
Mailing Address - Country:US
Mailing Address - Phone:910-259-1230
Mailing Address - Fax:910-259-1258
Practice Address - Street 1:803 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5001
Practice Address - Country:US
Practice Address - Phone:910-259-1230
Practice Address - Fax:910-259-1258
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC598286OtherUNITED CONCORDIA
NC8990466Medicaid
NC90466OtherBLUE CROSS BLUE SHIELD