Provider Demographics
NPI:1619077310
Name:BARAJAS, GILBERT JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:JOSEPH
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 W BEVERLY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3900
Mailing Address - Country:US
Mailing Address - Phone:323-727-6944
Mailing Address - Fax:323-727-7879
Practice Address - Street 1:1712 W BEVERLY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3900
Practice Address - Country:US
Practice Address - Phone:323-727-6944
Practice Address - Fax:323-727-7879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics