Provider Demographics
NPI:1134280183
Name:BARIUAN, NAOMI RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:RUTH
Last Name:BARIUAN
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 1:6144 GAZEBO PARK PL S
Mailing Address - Street 2:#210
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1099
Mailing Address - Country:US
Mailing Address - Phone:904-262-9466
Mailing Address - Fax:904-268-8648
Practice Address - Street 1:6144 GAZEBO PARK PL S
Practice Address - Street 2:#210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1099
Practice Address - Country:US
Practice Address - Phone:904-262-9466
Practice Address - Fax:904-268-8648
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00130321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice