Provider Demographics
NPI:1730314360
Name:BARRERA HAGEN, MARIA F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:F
Last Name:BARRERA HAGEN
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 1:140 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3213
Mailing Address - Country:US
Mailing Address - Phone:407-739-6979
Mailing Address - Fax:
Practice Address - Street 1:1694 W HIBISCUS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2636
Practice Address - Country:US
Practice Address - Phone:321-412-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist