Provider Demographics
NPI:1023109113
Name:IBARRA, EMILY TATE (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:TATE
Last Name:IBARRA
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 1:2D DENTAL SQUADRON
Mailing Address - Street 2:1067 TWINING DRIVE
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6718
Mailing Address - Fax:
Practice Address - Street 1:1067 TWINING DR
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2486
Practice Address - Country:US
Practice Address - Phone:183-456-6718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 177701223G0001X
LA75071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice