Provider Demographics
NPI:1568492171
Name:BARRETT, PAUL ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-6000
Mailing Address - Country:US
Mailing Address - Phone:336-342-3123
Mailing Address - Fax:336-342-4698
Practice Address - Street 1:1410 FRONT ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-6000
Practice Address - Country:US
Practice Address - Phone:336-342-3123
Practice Address - Fax:336-342-4698
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice