MEDICARE: GRETA DE FATIMA BARBA DMD

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
1	122300000X	Dentist	7268	NV
2	1223G0001X	General Practice Dentistry	7268	NV

General Provider Information

NPI Number	:	1891349239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETA DE FATIMA BARBA DMD

Provider Business Mailing Address
First Line	:	4300 EL COMO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6653
Country	:	US
Telephone Number	:	702-465-9628
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 E TROPICANA AVE STE F8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7357
Country	:	US
Telephone Number	:	702-964-3626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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Directions to “ GRETA DE FATIMA BARBA DMD” Practice Location

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