Provider Demographics
NPI:1750413316
Name:BARRETT, EDWARD E (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
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 1:3400 PENROSE PL
Mailing Address - Street 2:SUITE #104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1809
Mailing Address - Country:US
Mailing Address - Phone:303-443-1895
Mailing Address - Fax:303-442-2765
Practice Address - Street 1:3400 PENROSE PL
Practice Address - Street 2:SUITE #104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1809
Practice Address - Country:US
Practice Address - Phone:303-443-1895
Practice Address - Fax:303-442-2765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice