Provider Demographics
NPI:1073670576
Name:BARRETT, JOHN A (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4152 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7813
Mailing Address - Country:US
Mailing Address - Phone:214-520-1112
Mailing Address - Fax:214-520-1190
Practice Address - Street 1:5204 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6309
Practice Address - Country:US
Practice Address - Phone:903-455-2942
Practice Address - Fax:903-450-4066
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist