Provider Demographics
NPI:1891006649
Name:YBARRA, MARIA LAURA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LAURA
Last Name:YBARRA
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 1:19472 US ROUTE 11 STE 201-N
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6897
Mailing Address - Country:US
Mailing Address - Phone:153-681-6818
Mailing Address - Fax:
Practice Address - Street 1:19472 US ROUTE 11 STE 201-N
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6897
Practice Address - Country:US
Practice Address - Phone:315-681-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0559251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry