Healthcare Provider Details

I. General information

NPI: 1114145471
Provider Name (Legal Business Name): BETSY DORRIS BARCROFT D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 N QUAIL HOLLOW RD # - SUITE 101
MEMPHIS TN
38120-1437
US

IV. Provider business mailing address

6170 BOSKEY DR
MILLINGTON TN
38053-6900
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-8491
  • Fax: 901-682-8492
Mailing address:
  • Phone: 901-354-4299
  • Fax: 901-682-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number972
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberTN5017
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number113
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: