Provider Demographics
NPI:1578792735
Name:BARRIENTOS, KERRI L (DH)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:L
Last Name:BARRIENTOS
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BIRDSONG LANE
Mailing Address - Street 2:
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952
Mailing Address - Country:US
Mailing Address - Phone:509-874-2979
Mailing Address - Fax:509-874-2113
Practice Address - Street 1:401 BUSTER ROAD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948
Practice Address - Country:US
Practice Address - Phone:509-865-2102
Practice Address - Fax:509-865-8995
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-091445-L122300000X
WADH00005403124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5400171Medicaid