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NPI Code Detail

MEDICARE: DR. MIGUEL IBARRA DDS

MEDICARE: DR. MIGUEL IBARRA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry51477CA

General Provider Information

NPI Number : 1588648943
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIGUEL IBARRA DDS
Provider Business Mailing Address
First Line : 737 W CHILDS AVE
Second Line :
City : MERCED
State : CA
Zip : 95340-6805
Country : US
Telephone Number : 209-383-1848
Fax Number : 209-383-1296
Provider Business Practice Location Address
First Line : 200 C ST
Second Line :
City : PATTERSON
State : CA
Zip : 95363-2701
Country : US
Telephone Number : 209-892-6307
Fax Number : 209-892-2633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 05/30/2013

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