Provider Demographics
NPI:1003022906
Name:AMOG, BARBARA TUAZON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:TUAZON
Last Name:AMOG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39813 SHERIDAN CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8341
Mailing Address - Country:US
Mailing Address - Phone:951-677-9908
Mailing Address - Fax:
Practice Address - Street 1:39813 SHERIDAN CT
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8341
Practice Address - Country:US
Practice Address - Phone:951-677-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50433OtherDENTAL LICENSE NUMBER