Provider Demographics
NPI:1043311012
Name:BARRETT, MARK SHAWVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SHAWVER
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597
Mailing Address - Country:US
Mailing Address - Phone:919-269-9698
Mailing Address - Fax:919-269-9778
Practice Address - Street 1:313 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597
Practice Address - Country:US
Practice Address - Phone:919-269-9698
Practice Address - Fax:919-269-9778
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
90464OtherBCBS
90464OtherBCBS
NC8990464Medicare ID - Type Unspecified