Provider Demographics
NPI:1518317064
Name:BARROS, LEYDI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEYDI
Middle Name:
Last Name:BARROS
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 1:7060 DEER LODGE CIR
Mailing Address - Street 2:UNIT 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8566
Mailing Address - Country:US
Mailing Address - Phone:305-608-2005
Mailing Address - Fax:
Practice Address - Street 1:7451 103RD ST
Practice Address - Street 2:UNIT 18
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9300
Practice Address - Country:US
Practice Address - Phone:904-777-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist