Provider Demographics
NPI:1336387687
Name:BARRANCO, DEANNA LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LISA
Last Name:BARRANCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2504
Mailing Address - Country:US
Mailing Address - Phone:917-648-2913
Mailing Address - Fax:
Practice Address - Street 1:45 W 10TH ST
Practice Address - Street 2:SUITE LE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8763
Practice Address - Country:US
Practice Address - Phone:212-982-5883
Practice Address - Fax:212-982-1504
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0548491223G0001X
NJ22DI024176001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice