Provider Demographics
NPI:1144996521
Name:BARBA, AMANDA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:BARBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 LEBON DR UNIT 5119
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4508
Mailing Address - Country:US
Mailing Address - Phone:915-345-7922
Mailing Address - Fax:
Practice Address - Street 1:802 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3402
Practice Address - Country:US
Practice Address - Phone:915-345-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist