MEDICARE: DR. CODY EVAN BARRETT DDS

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	122300000X	Dentist	10670	NC

General Provider Information

NPI Number	:	1457871501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY EVAN BARRETT DDS

Provider Business Mailing Address
First Line	:	510 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3310
Country	:	US
Telephone Number	:	704-739-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3310
Country	:	US
Telephone Number	:	704-739-1331
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	07/21/2022

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