Provider Demographics
NPI:1194843490
Name:BARRAGAN, EDWARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:R
Other - Last Name:BARRAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:18276 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3472
Mailing Address - Country:US
Mailing Address - Phone:714-993-7910
Mailing Address - Fax:714-993-7155
Practice Address - Street 1:18276 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3472
Practice Address - Country:US
Practice Address - Phone:714-993-7910
Practice Address - Fax:714-993-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice