Provider Demographics
NPI:1588765424
Name:BARRETT, DONALD RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-9575
Mailing Address - Country:US
Mailing Address - Phone:815-234-2567
Mailing Address - Fax:
Practice Address - Street 1:2403 E OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-9575
Practice Address - Country:US
Practice Address - Phone:815-234-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-164541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice