Provider Demographics
NPI:1912402959
Name:JEFFREY C. BARRERA D.D.S. INC.
Entity type:Organization
Organization Name:JEFFREY C. BARRERA D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-371-8533
Mailing Address - Street 1:30901 GATEWAY PL.
Mailing Address - Street 2:F-5
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1858
Mailing Address - Country:US
Mailing Address - Phone:949-371-8533
Mailing Address - Fax:949-449-8444
Practice Address - Street 1:30901 GATEWAY PL.
Practice Address - Street 2:F-5
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1858
Practice Address - Country:US
Practice Address - Phone:949-371-8533
Practice Address - Fax:949-449-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40914261QD0000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental