Provider Demographics
NPI:1114145471
Name:BARCROFT, BETSY DORRIS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:DORRIS
Last Name:BARCROFT
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 BOSKEY DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-6900
Mailing Address - Country:US
Mailing Address - Phone:901-354-4299
Mailing Address - Fax:901-682-8492
Practice Address - Street 1:6425 N QUAIL HOLLOW RD # -
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1437
Practice Address - Country:US
Practice Address - Phone:901-682-8491
Practice Address - Fax:901-682-8492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK972122300000X
TNTN50171223P0221X
AK1131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK113OtherDENTAL SPECIALIST LICENSE
AKDD1972Medicaid
AKDD19721Medicaid
TNTN5017OtherDENTAL LICENSE NUMBER
AK972OtherDENTAL LICENSE NUMBER