Provider Demographics
NPI:1356801666
Name:BARRON, KIRA GENTLE (DMD)
Entity type:Individual
Prefix:DR
First Name:KIRA
Middle Name:GENTLE
Last Name:BARRON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIRA
Other - Middle Name:GENTLE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:629 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1756
Mailing Address - Country:US
Mailing Address - Phone:719-331-0780
Mailing Address - Fax:
Practice Address - Street 1:65 THIRD ST. SUITE 13
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-787-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1048791223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice