Provider Demographics
NPI:1821055344
Name:BARBOSA, DECIO ANDRADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DECIO
Middle Name:ANDRADE
Last Name:BARBOSA
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 1:16700 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-406-3000
Mailing Address - Fax:310-406-3309
Practice Address - Street 1:16700 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3243
Practice Address - Country:US
Practice Address - Phone:310-406-3000
Practice Address - Fax:310-406-3309
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice