Provider Demographics
NPI:1023175437
Name:BARRETT, JOHN THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
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 1:32 MAIN ST
Mailing Address - Street 2:WATERSIDE OFFICE PARK
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-2326
Mailing Address - Country:US
Mailing Address - Phone:860-623-3244
Mailing Address - Fax:
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:WATERSIDE OFFICE PARK
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2326
Practice Address - Country:US
Practice Address - Phone:860-623-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice