Provider Demographics
NPI:1679900823
Name:BARRETT, DUSTIN FRANK
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:FRANK
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2969 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:OFALLON
Mailing Address - State:IL
Mailing Address - Zip Code:63366-7862
Mailing Address - Country:US
Mailing Address - Phone:636-379-4691
Mailing Address - Fax:636-379-4820
Practice Address - Street 1:2969 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7862
Practice Address - Country:US
Practice Address - Phone:636-379-4691
Practice Address - Fax:636-379-4820
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012042743237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012042743OtherHEARING AID DISPENSER LICENSE