Healthcare Provider Details

I. General information

NPI: 1871021113
Provider Name (Legal Business Name): JOHN BARRETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 VISTA KNOLL PKWY
RENO NV
89506-5647
US

IV. Provider business mailing address

6900 SHARLANDS AVE UNIT 1225
RENO NV
89523-2914
US

V. Phone/Fax

Practice location:
  • Phone: 775-971-9282
  • Fax:
Mailing address:
  • Phone: 801-815-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-110
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: