MEDICARE: DR. ARTURO IBARRA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	31287	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B31287-01	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1386787976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTURO IBARRA D.D.S.

Provider Business Mailing Address
First Line	:	2407 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2218
Country	:	US
Telephone Number	:	323-221-3165
Fax Number	:	323-221-0112

Provider Business Practice Location Address
First Line	:	2407 N BROADWAY AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2218
Country	:	US
Telephone Number	:	323-221-3165
Fax Number	:	323-221-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ARTURO IBARRA D.D.S.” Practice Location

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