Provider Demographics
NPI:1013930239
Name:BARRERA, ROGELIO AVALOS (DDS)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:AVALOS
Last Name:BARRERA
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 1:812 4TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901
Mailing Address - Country:US
Mailing Address - Phone:530-742-6971
Mailing Address - Fax:
Practice Address - Street 1:812 4TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901
Practice Address - Country:US
Practice Address - Phone:530-742-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice