Active NPI
Derek Ibarra, DDS
- Pediatric Dentistry
- Houston, TX
National Provider Identifier
1083119374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 37046
- Practice address
- 12700 N Featherwood Dr Ste 290
Houston, TX 77034-4496 - Phone
- (819) 494-4562
- NPI assigned
- Mar 28, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 37046 | TX | Primary |
Addresses
Primary practice location
12700 N Featherwood Dr Ste 290
Houston, TX 77034-4496
Mailing address
2900 University Ave SE Apt 510
Minneapolis, MN 55414-3738
Phone (319) 321-6426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180717000274 | VA | Order and Referring Only - Dentist | 1052668449 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37046 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647388800000",
"number": "1083119374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 UNIVERSITY AVE SE APT 510",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554143738",
"telephone_number": "319-321-6426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12700 N FEATHERWOOD DR STE 290",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770344496",
"telephone_number": "819-494-4562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBARRA",
"first_name": "DEREK",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-28",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "37046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.