Provider Demographics
NPI:1184887945
Name:RON BARBIERI DDS, INC
Entity type:Organization
Organization Name:RON BARBIERI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARBIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-543-5321
Mailing Address - Street 1:1131 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3301
Mailing Address - Country:US
Mailing Address - Phone:805-543-0753
Mailing Address - Fax:
Practice Address - Street 1:1131 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3301
Practice Address - Country:US
Practice Address - Phone:805-543-0753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB26032-01Medicaid