MEDICARE: DR. MAXIMILIAN MAGALA BAUTISTA D.D.S

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	45822	CA

General Provider Information

NPI Number	:	1568656080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXIMILIAN MAGALA BAUTISTA D.D.S

Provider Business Mailing Address
First Line	:	2664 BERRYESSA RD
Second Line	:	SUITE 201
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2925
Country	:	US
Telephone Number	:	408-272-2330
Fax Number	:	408-272-2665

Provider Business Practice Location Address
First Line	:	2664 BERRYESSA RD
Second Line	:	SUITE 201
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2925
Country	:	US
Telephone Number	:	408-272-2330
Fax Number	:	408-272-2665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	12/16/2025

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