Provider Demographics
NPI:1295812758
Name:BARRETT, RICHARD D (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
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 1:213 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5351
Mailing Address - Country:US
Mailing Address - Phone:712-328-9505
Mailing Address - Fax:
Practice Address - Street 1:40 NORTHCREST DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1622
Practice Address - Country:US
Practice Address - Phone:712-323-7589
Practice Address - Fax:712-323-8255
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA58881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0142679Medicaid