Provider Demographics
NPI:1861996183
Name:BARNES, LISA (DDS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
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 1:10125 JUNCTION DR APT 428
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS JUNCTION
Mailing Address - State:MD
Mailing Address - Zip Code:20701-1247
Mailing Address - Country:US
Mailing Address - Phone:757-813-4475
Mailing Address - Fax:
Practice Address - Street 1:7008 SECURITY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2568
Practice Address - Country:US
Practice Address - Phone:410-277-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD68793173122300000X
MD169011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist