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General NPI Number Information
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NPI Number | 1588784458
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Entity Type | Organization
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Legal Business Name | BACHOUR DENTAL CORPORATION
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3605 HOSPITAL RD SUITE A
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City | ATWATER
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State | CA
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Zip | 95301-5173
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Country | US
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Telephone | 209-381-2005
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Fax | 209-381-2036
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Provider Business Mailing Address
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Address Line | 3605 HOSPITAL RD SUITE A
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City | ATWATER
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State | CA
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Zip | 95301-5173
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Country | US
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Telephone | 209-381-2005
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Fax | 209-381-2036
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Authorized Official
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Title or Position | CFO
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Name | DR. MOUNZER BACHOUR
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Credential | DMD
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Telephone | 209-381-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48292
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License Number State | CA
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