MEDICARE: BRUCE J BARRETTE DDS SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1594G	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639228497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE J BARRETTE DDS SC

Provider Business Mailing Address
First Line	:	1710 CLEVELAND AVE
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143
Country	:	US
Telephone Number	:	715-732-1332
Fax Number	:	715-732-1060

Provider Business Practice Location Address
First Line	:	1710 CLEVELAND AVE
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143
Country	:	US
Telephone Number	:	715-732-1332
Fax Number	:	715-732-1060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE JAMES BARRETTE
Credential	:	DDS
Telephone Number	:	715-732-1332

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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