Provider Demographics
NPI:1275727513
Name:BARAK, ANDREW SEAN (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SEAN
Last Name:BARAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5244
Mailing Address - Country:US
Mailing Address - Phone:916-736-3101
Mailing Address - Fax:916-736-3075
Practice Address - Street 1:1315 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5244
Practice Address - Country:US
Practice Address - Phone:916-736-3101
Practice Address - Fax:916-736-3075
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45817OtherLICENSE NUMBER