Provider Demographics
NPI:1740291665
Name:BARRIENTOS, RAUL LEONARDO
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:LEONARDO
Last Name:BARRIENTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12419 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4305
Mailing Address - Country:US
Mailing Address - Phone:202-527-5227
Mailing Address - Fax:
Practice Address - Street 1:12419 CONNECTICUT AVE.
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:202-527-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048461-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist