Provider Demographics
NPI:1417344524
Name:BARRETT, CARLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
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 1:5885 LAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2007
Mailing Address - Country:US
Mailing Address - Phone:714-893-7571
Mailing Address - Fax:714-893-7573
Practice Address - Street 1:5885 LAMPSON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2007
Practice Address - Country:US
Practice Address - Phone:714-893-7571
Practice Address - Fax:714-893-7573
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice