Provider Demographics
NPI:1255743563
Name:BARRATT, TANNER
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:BARRATT
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 1:1450 E SOUTH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-1868
Mailing Address - Country:US
Mailing Address - Phone:928-425-8175
Mailing Address - Fax:
Practice Address - Street 1:1450 E SOUTH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1868
Practice Address - Country:US
Practice Address - Phone:928-425-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0089531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice