Provider Demographics
NPI:1326532599
Name:BARRETT, KIMBERLY SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8794 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-1221
Mailing Address - Country:US
Mailing Address - Phone:231-893-5815
Mailing Address - Fax:231-893-1128
Practice Address - Street 1:8794 SPRING ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1221
Practice Address - Country:US
Practice Address - Phone:231-893-5815
Practice Address - Fax:231-893-1128
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-01-23
Deactivation Date:2020-01-16
Deactivation Code:
Reactivation Date:2020-01-22
Provider Licenses
StateLicense IDTaxonomies
MI26010226901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice