Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 9005 | SC |
NPI | 1104212372 |
---|---|
Provider Name | Rosaria Barnes |
First Address | Racine, WI 53403-9607 |
Second Address | Mount Pleasant, SC 29464-3685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 06/12/2019 |