Provider Demographics
NPI:1760911861
Name:BARRERO, ODELSIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ODELSIS
Middle Name:
Last Name:BARRERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 SW 153RD CT APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1734
Mailing Address - Country:US
Mailing Address - Phone:239-304-6579
Mailing Address - Fax:
Practice Address - Street 1:17 W CANAL ST N STE A
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3078
Practice Address - Country:US
Practice Address - Phone:561-996-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL226031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice