Healthcare Provider Details

I. General information

NPI: 1770925836
Provider Name (Legal Business Name): JUILEE BARIDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 BALFOUR RD SUITE C
BRENTWOOD CA
94513-5519
US

IV. Provider business mailing address

3150 BALFOUR RD SUITE C
BRENTWOOD CA
94513-5519
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-9640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number64296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: