Healthcare Provider Details

I. General information

NPI: 1063142339
Provider Name (Legal Business Name): DAISY VAYESDY BARAJAS MOTA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26635 WOODWARD AVE STE 200
HUNTINGTON WOODS MI
48070-1372
US

IV. Provider business mailing address

1586 HILLMONT AVE
SAN JOSE CA
95127-4521
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-6046
  • Fax:
Mailing address:
  • Phone: 408-807-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: