Provider Demographics
NPI:1760750236
Name:BARATH, STEPHEN DOW (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOW
Last Name:BARATH
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:P.O. BOX 867
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-0867
Mailing Address - Country:US
Mailing Address - Phone:909-337-4222
Mailing Address - Fax:
Practice Address - Street 1:28200 HIGHWAY 189
Practice Address - Street 2:SUITE 01-250
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-0867
Practice Address - Country:US
Practice Address - Phone:909-337-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD260311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice