Healthcare Provider Details

I. General information

NPI: 1447904834
Provider Name (Legal Business Name): BIANCA ABOUBAKARE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 E MUIRFIELD ST
GILBERT AZ
85298-0023
US

IV. Provider business mailing address

476 TEHAMA ST APT A
SAN FRANCISCO CA
94103-4374
US

V. Phone/Fax

Practice location:
  • Phone: 714-264-4156
  • Fax:
Mailing address:
  • Phone: 714-264-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS105692
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number011586
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS105692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: