Provider Demographics
NPI:1740323179
Name:BARNETT, MICHAEL ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BARNETT
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 1:9200 TAYLORSVILLE RD
Mailing Address - Street 2:111
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1786
Mailing Address - Country:US
Mailing Address - Phone:502-671-0606
Mailing Address - Fax:502-671-1005
Practice Address - Street 1:9200 TAYLORSVILLE RD
Practice Address - Street 2:111
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1786
Practice Address - Country:US
Practice Address - Phone:502-671-0606
Practice Address - Fax:502-671-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice