MEDICARE: DR. BLAIR RUSS BARNETT D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	23168	TX

General Provider Information

NPI Number	:	1114133972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR RUSS BARNETT D.D.S., M.S.

Provider Business Mailing Address
First Line	:	12171 W PARMER LN
Second Line	:	SUITE 102
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7361
Country	:	US
Telephone Number	:	512-260-0084
Fax Number	:

Provider Business Practice Location Address
First Line	:	12171 W PARMER LN
Second Line	:	SUITE 102
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7361
Country	:	US
Telephone Number	:	512-260-0084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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