Provider Demographics
NPI:1053929778
Name:BARRETT, TRAVIS (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W PORT PLZ STE 367
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3124
Mailing Address - Country:US
Mailing Address - Phone:314-434-4676
Mailing Address - Fax:
Practice Address - Street 1:77 W PORT PLZ STE 367
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3124
Practice Address - Country:US
Practice Address - Phone:314-434-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022465122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist