MEDICARE: DR. JASON LAWRENCE BARRETT DDS

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	122300000X	Dentist	15405	MD
2	1223G0001X	General Practice Dentistry	13166	NC

General Provider Information

NPI Number	:	1649607946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON LAWRENCE BARRETT DDS

Provider Business Mailing Address
First Line	:	161 KODIAK LN
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-5399
Country	:	US
Telephone Number	:	336-789-1025
Fax Number	:	336-789-1158

Provider Business Practice Location Address
First Line	:	161 KODIAK LN
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-5399
Country	:	US
Telephone Number	:	336-789-1025
Fax Number	:	336-789-1158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	07/11/2023

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