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General NPI Number Information
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NPI Number | 1083119374
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Entity Type | Individual
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Provider Name | DEREK IBARRA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 12700 N FEATHERWOOD DR STE 290
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City | HOUSTON
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State | TX
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Zip | 77034-4496
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Country | US
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Telephone | 819-494-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 UNIVERSITY AVE SE APT 510
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3738
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Country | US
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Telephone | 319-321-6426
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 37046
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License Number State | TX
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