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General NPI Number Information
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NPI Number | 1457712200
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Entity Type | Organization
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Legal Business Name | ARTURO IBARRA D.D.S. INC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 2407 NORTH BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031
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Country | US
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Telephone | 323-221-3165
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Fax | 323-221-3188
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Provider Business Mailing Address
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Address Line | 2407 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2218
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Country | US
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Telephone | 323-221-3165
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Fax | 323-221-3188
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARTURO IBARRA
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Credential | D.D.S.
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Telephone | 323-221-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31287
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License Number State | CA
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