Provider Demographics
NPI:1205447752
Name:DAVIDSON, BARRET J (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRET
Middle Name:J
Last Name:DAVIDSON
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 1:6110 SAINTSBURY DR APT 318
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5291
Mailing Address - Country:US
Mailing Address - Phone:817-307-8182
Mailing Address - Fax:
Practice Address - Street 1:106 N COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4736
Practice Address - Country:US
Practice Address - Phone:972-231-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice