Provider Demographics
NPI:1982765194
Name:BARAKAT, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BARAKAT
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 1:4275 ROCKLIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3456
Mailing Address - Country:US
Mailing Address - Phone:916-632-2181
Mailing Address - Fax:916-632-9392
Practice Address - Street 1:4275 ROCKLIN RD #B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3456
Practice Address - Country:US
Practice Address - Phone:916-632-2181
Practice Address - Fax:916-632-9392
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA686125822Medicaid