Healthcare Provider Details

I. General information

NPI: 1649885815
Provider Name (Legal Business Name): BRONEIL ISHAYA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE STE 280
TURLOCK CA
95382-2708
US

IV. Provider business mailing address

1801 COLORADO AVE STE 280
TURLOCK CA
95382-2708
US

V. Phone/Fax

Practice location:
  • Phone: 209-277-0981
  • Fax:
Mailing address:
  • Phone: 209-277-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number105491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: