=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710774492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASSAM EKRAM MICHIEL DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N I ST
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-673-2268
-----------------------------------------------------
Fax | 559-673-2226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 N I ST
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-673-2268
-----------------------------------------------------
Fax | 559-673-2226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BASSAM EKRAM MICHIEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 559-673-2268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------