Healthcare Provider Details

I. General information

NPI: 1467933739
Provider Name (Legal Business Name): KANIKA BEMBEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 W MONTE VISTA AVE
TURLOCK CA
95380-8409
US

IV. Provider business mailing address

34483 ALBERTA TER
FREMONT CA
94555-2908
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-2879
  • Fax:
Mailing address:
  • Phone: 805-312-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number103138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: