Healthcare Provider Details

I. General information

NPI: 1710774492
Provider Name (Legal Business Name): BASSAM EKRAM MICHIEL DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N I ST
MADERA CA
93637-3070
US

IV. Provider business mailing address

515 N I ST
MADERA CA
93637-3070
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-2268
  • Fax: 559-673-2226
Mailing address:
  • Phone: 559-673-2268
  • Fax: 559-673-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: BASSAM EKRAM MICHIEL
Title or Position: OWNER
Credential: DDS
Phone: 559-673-2268