Provider Demographics
NPI:1760529507
Name:BARRETT, JENIFER M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8912
Mailing Address - Country:US
Mailing Address - Phone:912-537-3739
Mailing Address - Fax:912-537-3796
Practice Address - Street 1:514 MAPLE DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8912
Practice Address - Country:US
Practice Address - Phone:912-537-3739
Practice Address - Fax:912-537-3796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0121051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice