Healthcare Provider Details

I. General information

NPI: 1245405208
Provider Name (Legal Business Name): BARNETT DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 HULEN BEND BLVD
FORT WORTH TX
76132-2803
US

IV. Provider business mailing address

6222 HULEN BEND BLVD
FORT WORTH TX
76132-2803
US

V. Phone/Fax

Practice location:
  • Phone: 817-546-3335
  • Fax: 817-546-3339
Mailing address:
  • Phone: 817-546-3335
  • Fax: 817-546-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22966
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN LAWRENCE BARNETT II
Title or Position: DENTIST
Credential: D.D.S.
Phone: 817-546-3335