Provider Demographics
NPI:1689740672
Name:BARAR, GOLY MOTAMENI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOLY
Middle Name:MOTAMENI
Last Name:BARAR
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 1:3221 JEFFERSON AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3096
Mailing Address - Country:US
Mailing Address - Phone:650-365-3516
Mailing Address - Fax:650-365-6166
Practice Address - Street 1:3221 JEFFERSON AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3096
Practice Address - Country:US
Practice Address - Phone:650-365-3516
Practice Address - Fax:650-365-6166
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46555OtherDENTAL LICENSE