Provider Demographics
NPI:1578355566
Name:BARBA, CASANDRA ALICIA
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:ALICIA
Last Name:BARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 S SANTA CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-6046
Mailing Address - Country:US
Mailing Address - Phone:575-694-3118
Mailing Address - Fax:
Practice Address - Street 1:1315 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4949
Practice Address - Country:US
Practice Address - Phone:575-546-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPENDING1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice