Provider Demographics
NPI:1679730790
Name:BARNES, ALYSON TERRY (DDS)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:TERRY
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 1:18395 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3961
Mailing Address - Country:US
Mailing Address - Phone:503-642-4552
Mailing Address - Fax:503-591-0202
Practice Address - Street 1:18395 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-3961
Practice Address - Country:US
Practice Address - Phone:503-642-4552
Practice Address - Fax:503-591-0202
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606328601223E0200X
FLDN185631223G0001X
MADN 18551331223G0001X
390200000X
ORD98291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program