Provider Demographics
NPI:1962702050
Name:BARRETT, JENNIFER ALTHEA (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALTHEA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ALTHEA
Other - Last Name:GRANLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2520 N. ALDER ST.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-572-6670
Mailing Address - Fax:253-572-9982
Practice Address - Street 1:2520 N. ALDER ST.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-572-6670
Practice Address - Fax:253-572-9982
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60167790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist