Provider Demographics
NPI:1740659812
Name:BARRETT, JEREMY GEORGE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:GEORGE
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 HIGUERA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3166
Mailing Address - Country:US
Mailing Address - Phone:805-541-3411
Mailing Address - Fax:805-541-3792
Practice Address - Street 1:1223 HIGUERA ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3166
Practice Address - Country:US
Practice Address - Phone:775-250-3021
Practice Address - Fax:805-541-3792
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics