Provider Demographics
NPI:1487781878
Name:BURKETT, BARRY L (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:BURKETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 FAUBUSH RD
Mailing Address - Street 2:
Mailing Address - City:FAUBUSH
Mailing Address - State:KY
Mailing Address - Zip Code:42544-6587
Mailing Address - Country:US
Mailing Address - Phone:606-871-7800
Mailing Address - Fax:606-871-0328
Practice Address - Street 1:87 SARAHS LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2789
Practice Address - Country:US
Practice Address - Phone:606-679-3010
Practice Address - Fax:606-679-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53951223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist