Healthcare Provider Details

I. General information

NPI: 1245542810
Provider Name (Legal Business Name): JENNIFER BARTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 GEORGE WASHINGTON MEM HWY
GRAFTON VA
23692-2880
US

IV. Provider business mailing address

4310 GEORGE WASHINGTON MEM HWY
GRAFTON VA
23692-2880
US

V. Phone/Fax

Practice location:
  • Phone: 757-898-5448
  • Fax:
Mailing address:
  • Phone: 757-898-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401410583
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: