Provider Demographics
NPI:1487899068
Name:BARNES, GORDON
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 US HIGHWAY 9
Mailing Address - Street 2:SUITE 367
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3239
Mailing Address - Country:US
Mailing Address - Phone:732-308-9061
Mailing Address - Fax:732-308-4361
Practice Address - Street 1:345 US HIGHWAY 9
Practice Address - Street 2:SUITE 367
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3239
Practice Address - Country:US
Practice Address - Phone:732-308-9061
Practice Address - Fax:732-308-4361
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist