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General NPI Number Information
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NPI Number | 1053929778
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Entity Type | Individual
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Provider Name | TRAVIS BARRETT DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 05/19/2024
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Provider Practice Location Address
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Address Line | 77 W PORT PLZ STE 367
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3124
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Country | US
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Telephone | 314-434-4676
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Fax |
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Provider Business Mailing Address
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Address Line | 77 W PORT PLZ STE 367
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3124
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Country | US
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Telephone | 314-434-4676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2020022465
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2020022465
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License Number State | MO
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