Provider Demographics
NPI:1558245233
Name:BARBA, MARTIN MATTHEW XAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MATTHEW XAVIER
Last Name:BARBA
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 1:1206 E CHAMPLAIN DR APT 206
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5061
Mailing Address - Country:US
Mailing Address - Phone:323-944-9373
Mailing Address - Fax:
Practice Address - Street 1:1255 W SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-3938
Practice Address - Country:US
Practice Address - Phone:559-490-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1121691223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice