Provider Demographics
NPI:1760020564
Name:KIMBERLY S BARRETT DDS PLLC
Entity type:Organization
Organization Name:KIMBERLY S BARRETT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-903-2069
Mailing Address - Street 1:6526 TERRAVITA DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9346
Mailing Address - Country:US
Mailing Address - Phone:231-903-2069
Mailing Address - Fax:
Practice Address - Street 1:8794 SPRING ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1221
Practice Address - Country:US
Practice Address - Phone:231-893-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty