Provider Demographics
NPI:1477446888
Name:BARRETT, JACQUELYNNE WYETH
Entity type:Individual
Prefix:
First Name:JACQUELYNNE
Middle Name:WYETH
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 STARK RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4638
Mailing Address - Country:US
Mailing Address - Phone:603-781-4227
Mailing Address - Fax:
Practice Address - Street 1:60 GARDNER ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1211
Practice Address - Country:US
Practice Address - Phone:978-372-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH13778124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist