Provider Demographics
NPI:1255338372
Name:ULIBARRI, MITCHELL ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALLEN
Last Name:ULIBARRI
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 1:1912 CRESTON RD
Mailing Address - Street 2:STE A
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4403
Mailing Address - Country:US
Mailing Address - Phone:805-238-1787
Mailing Address - Fax:
Practice Address - Street 1:1912 CRESTON RD
Practice Address - Street 2:STE A
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4403
Practice Address - Country:US
Practice Address - Phone:805-238-1787
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice