Mark A Barrette, DDS – General Practice Dentistry

Key facts

NPI: 1154480655
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 1595G (WI)
Practice address: 215 N Spring St
Beaver Dam, WI 53916-2137
Phone: (920) 885-6066
NPI assigned: Dec 8, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Larsen Family Dental S.C. Dentist · Beaver Dam, WI · NPI 1245280742

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1595G	WI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Larsen Family Dental S.C.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	1595G	WI	Yes

Addresses

Primary practice location

215 N Spring St
Beaver Dam, WI 53916-2137

Mailing address

215 N Spring St
Beaver Dam, WI 53916-2137
Phone (920) 885-6066

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154480655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N SPRING ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162137",
            "telephone_number": "920-885-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N SPRING ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162137",
            "telephone_number": "920-885-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRETTE",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1595G",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

All providers in Beaver Dam, WI · General Practice Dentistry in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.