Provider Demographics
NPI:1316542350
Name:BARNETT DALLAS PERIODONTICS PLLC
Entity Type:Organization
Organization Name:BARNETT DALLAS PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:214-691-2614
Mailing Address - Street 1:8401 N CENTRAL EXPY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4423
Mailing Address - Country:US
Mailing Address - Phone:214-691-2614
Mailing Address - Fax:
Practice Address - Street 1:8401 N CENTRAL EXPY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4423
Practice Address - Country:US
Practice Address - Phone:214-691-2614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty