Provider Demographics
NPI:1982365714
Name:ANDREASEN, BARETT D (DDS)
Entity Type:Individual
Prefix:
First Name:BARETT
Middle Name:D
Last Name:ANDREASEN
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 1:914 W BROOKCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4501
Mailing Address - Country:US
Mailing Address - Phone:505-331-1014
Mailing Address - Fax:
Practice Address - Street 1:914 W BROOKCREST CIR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4501
Practice Address - Country:US
Practice Address - Phone:424-226-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12185012-99211223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology