MEDICARE: MG BACHOUR DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44826	CA

General Provider Information

NPI Number	:	1205956174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG BACHOUR DDS INC

Provider Business Mailing Address
First Line	:	700 W OLIVE AVE
Second Line	:	SUITE. E
City	:	MERCED
State	:	CA
Zip	:	95348-2435
Country	:	US
Telephone Number	:	209-723-5005
Fax Number	:	209-381-2036

Provider Business Practice Location Address
First Line	:	700 W OLIVE AVE
Second Line	:	SUITE. E
City	:	MERCED
State	:	CA
Zip	:	95348-2435
Country	:	US
Telephone Number	:	209-723-5005
Fax Number	:	209-381-2036

Authorized Official
Title or Position	:	CEO
Name	:	DR. MOUNZER BACHOUR
Credential	:	DMD
Telephone Number	:	209-723-5005

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/02/2013

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