Provider Demographics
NPI:1669542304
Name:BARRAGAN, MARTHA E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:E
Last Name:BARRAGAN
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 1:634 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3012
Mailing Address - Country:US
Mailing Address - Phone:408-288-5490
Mailing Address - Fax:408-288-4072
Practice Address - Street 1:634 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3012
Practice Address - Country:US
Practice Address - Phone:408-288-5490
Practice Address - Fax:408-288-4072
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice