Healthcare Provider Details

I. General information

NPI: 1417002106
Provider Name (Legal Business Name): ROBERT LESTER BARRETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 HIGHWAY 367 N
BALD KNOB AR
72010-3165
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-724-6207
  • Fax: 870-347-3492
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2146 (17)
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2146
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: