Provider Demographics
NPI:1518488055
Name:BARNETT, SETH THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:THOMAS
Last Name:BARNETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 GENERAL ELECTRIC RD STE 6
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8566
Mailing Address - Country:US
Mailing Address - Phone:309-663-9521
Mailing Address - Fax:
Practice Address - Street 1:3601 GENERAL ELECTRIC RD STE 6
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8566
Practice Address - Country:US
Practice Address - Phone:309-663-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210030641223E0200X
IL0190311691223G0001X
OH30.0254761223G0001X
IL021.0030641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice