Provider Demographics
NPI:1982618039
Name:BARRETT, SCOTT B (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SHERMER RD
Mailing Address - Street 2:202W
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5340
Mailing Address - Country:US
Mailing Address - Phone:847-480-0310
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERMER RD
Practice Address - Street 2:202W
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5340
Practice Address - Country:US
Practice Address - Phone:847-480-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice