Healthcare Provider Details

I. General information

NPI: 1013620749
Provider Name (Legal Business Name): MARWAN AL-BARRAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 CENTRAL PARK BLVD UNIT 203
DENVER CO
80238-2300
US

IV. Provider business mailing address

2373 CENTRAL PARK BLVD UNIT 203
DENVER CO
80238-2300
US

V. Phone/Fax

Practice location:
  • Phone: 404-245-3604
  • Fax:
Mailing address:
  • Phone: 404-245-3604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN.00205455
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: