Healthcare Provider Details

I. General information

NPI: 1942203468
Provider Name (Legal Business Name): PETER R. BARNETT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 W PARKER RD STE 500
PLANO TX
75093-6430
US

IV. Provider business mailing address

5944 W PARKER RD STE 500
PLANO TX
75093-6430
US

V. Phone/Fax

Practice location:
  • Phone: 972-943-5944
  • Fax: 972-801-9005
Mailing address:
  • Phone: 972-943-5944
  • Fax: 972-801-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: