=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982996864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT J BARNETT DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2011
-----------------------------------------------------
Last Update Date | 06/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 RIDGEWAY ST
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-624-7129
-----------------------------------------------------
Fax | 501-624-2471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 RIDGEWAY ST
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-624-7129
-----------------------------------------------------
Fax | 501-624-2471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAID / FRONT ONFFICE
-----------------------------------------------------
Name | TAMMY GARRETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-624-7129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2481
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------