MEDICARE: BARNETT FAMILY DENTAL DDD, PC

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	MO14128	MO

General Provider Information

NPI Number	:	1922002948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNETT FAMILY DENTAL DDD, PC

Provider Business Mailing Address
First Line	:	1427 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-581-3600
Fax Number	:	471-581-8899

Provider Business Practice Location Address
First Line	:	1427 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-581-3600
Fax Number	:	471-581-8899

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARCUS CARNEY BARNETT
Credential	:	DDS
Telephone Number	:	417-581-3600

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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