=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235505751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD D BARNETT DMD PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2015
-----------------------------------------------------
Last Update Date | 08/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 S 10TH ST
-----------------------------------------------------
City | MIDDLESBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40965-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-248-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 S 10TH ST
-----------------------------------------------------
City | MIDDLESBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40965-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-248-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD D BARNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-248-7505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6553
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------