Healthcare Provider Details

I. General information

NPI: 1033982830
Provider Name (Legal Business Name): MOKBIL AND BAUTISTA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 SAN RAMON VALLEY BLVD STE C6
SAN RAMON CA
94583-3456
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 925-395-2786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AHMAD MOKBIL
Title or Position: OWNER
Credential:
Phone: 714-845-8890