Individual provider Active NPI

Xichel Barreto Lara

  • Dentist
  • Passaic, NJ
National Provider Identifier
1881587632
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI03094000 Issued in NJ
Practice address
124 Gregory Ave Ste 303
Passaic, NJ 07055-4856
Phone
(197) 385-9053
NPI assigned
May 30, 2025
Last updated
Aug 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI03094000 NJ Primary

Addresses

Primary practice location

124 Gregory Ave Ste 303
Passaic, NJ 07055-4856

Mailing address

113 Sunset PL
Palisades Park, NJ 07650-1926
Phone (786) 803-9392

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
22DI03094000NJMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1881587632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 SUNSET PL",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501926",
            "telephone_number": "786-803-9392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 GREGORY AVE STE 303",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554856",
            "telephone_number": "197-385-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRETO LARA",
        "first_name": "XICHEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI03094000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.