Healthcare Provider Details

I. General information

NPI: 1023175437
Provider Name (Legal Business Name): JOHN THOMAS BARRETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MAIN ST WATERSIDE OFFICE PARK
WINDSOR LOCKS CT
06096-2326
US

IV. Provider business mailing address

32 MAIN ST WATERSIDE OFFICE PARK
WINDSOR LOCKS CT
06096-2326
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-3244
  • Fax:
Mailing address:
  • Phone: 860-623-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number005446
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: