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General NPI Number Information
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NPI Number | 1013527365
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Entity Type | Individual
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Provider Name | MARYIAM ELIZABETH BARKHO
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Gender | Female
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Dates
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Enumeration Date | 08/02/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 809 SOUTH MAIN STREET SUITE B
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City | SANTA ANA
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State | CA
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Zip | 92701
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Country | US
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Telephone | 800-755-9771
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Fax |
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Provider Business Mailing Address
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Address Line | 3138 MANISTEE DR
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City | COSTA MESA
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State | CA
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Zip | 92626-3124
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Country | US
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Telephone | 714-785-6512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 105001
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105001
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License Number State | CA
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