Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3675 | SC |
NPI | 1063465136 |
---|---|
Provider Name | Dr. Todd Reed Barrett |
First Address | Columbia, SC 29204-4313 |
Second Address | Columbia, SC 29204-4313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZX3675 | (05) | SC |