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General NPI Number Information
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NPI Number | 1548047772
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Entity Type | Individual
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Provider Name | ELYA BACH DDS
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 9331 MISSION GORGE RD
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City | SANTEE
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State | CA
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Zip | 92071-3882
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Country | US
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Telephone | 619-448-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 4402 EMERALD ST
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City | TORRANCE
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State | CA
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Zip | 90503-3033
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Country | US
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Telephone | 310-489-1946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS109140
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License Number State | CA
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