Provider Demographics
NPI:1881024750
Name:BARRETT FAMILY DENTAL PC
Entity Type:Organization
Organization Name:BARRETT FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-690-9667
Mailing Address - Street 1:1865 NW 169TH PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7327
Mailing Address - Country:US
Mailing Address - Phone:503-690-9667
Mailing Address - Fax:503-533-7010
Practice Address - Street 1:1865 NW 169TH PL
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7327
Practice Address - Country:US
Practice Address - Phone:503-690-9667
Practice Address - Fax:503-533-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty