Healthcare Provider Details

I. General information

NPI: 1912402959
Provider Name (Legal Business Name): JEFFREY C. BARRERA D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 05/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 GATEWAY PL. F-5
RANCHO MISSION VIEJO CA
92694-1858
US

IV. Provider business mailing address

30901 GATEWAY PL. F-5
RANCHO MISSION VIEJO CA
92694-1858
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-8533
  • Fax: 949-449-8444
Mailing address:
  • Phone: 949-371-8533
  • Fax: 949-449-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number40914
License Number StateCA

VIII. Authorized Official

Name: JEFFREY C BARRERA
Title or Position: OWNER
Credential: DDS
Phone: 949-371-8533