Healthcare Provider Details

I. General information

NPI: 1417799834
Provider Name (Legal Business Name): ALLISON BARAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 E GARVEY AVE N # B
WEST COVINA CA
91791-1500
US

IV. Provider business mailing address

144 S ALTA VISTA BLVD
LOS ANGELES CA
90036-2824
US

V. Phone/Fax

Practice location:
  • Phone: 626-605-0168
  • Fax:
Mailing address:
  • Phone: 323-403-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: