Provider Demographics
NPI:1114133972
Name:BARNETT, BLAIR RUSS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:RUSS
Last Name:BARNETT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12171 W PARMER LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7361
Mailing Address - Country:US
Mailing Address - Phone:512-260-0084
Mailing Address - Fax:
Practice Address - Street 1:12171 W PARMER LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7361
Practice Address - Country:US
Practice Address - Phone:512-260-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics