=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477446888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELYNNE WYETH BARRETT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 GARDNER ST
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01834-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-372-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 STARK RD
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-4638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-781-4227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH13778
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------