Provider Demographics
NPI:1972538403
Name:BARRETT, GEORGE CLINT (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:CLINT
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 1:7515 QUAKER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5317
Mailing Address - Country:US
Mailing Address - Phone:806-792-6291
Mailing Address - Fax:806-792-6329
Practice Address - Street 1:2420 QUAKER AVE
Practice Address - Street 2:STE 102
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-792-6291
Practice Address - Fax:806-792-6329
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140577101Medicaid
TX00949EMedicare ID - Type Unspecified