Individual
BREANNA BARNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1439 STILLWATER AVE STE 7, CHEYENNE, WY 82009-7367
(307) 778-7100
Mailing address
1439 STILLWATER AVE STE 7, CHEYENNE, WY 82009-7367
(307) 778-7100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
61240
KS
1223P0221X
Pediatric Dentistry
Primary
1507
WY
1223P0221X
Pediatric Dentistry
61240
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004134062
UNITED CONCORDIA DENTAL
WY
Enumeration date
04/07/2014
Last updated
10/30/2018
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