Provider Demographics
NPI:1124133012
Name:BAGHA, FERIAL (DDS)
Entity type:Individual
Prefix:
First Name:FERIAL
Middle Name:
Last Name:BAGHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 MCKEE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1615
Mailing Address - Country:US
Mailing Address - Phone:408-251-3750
Mailing Address - Fax:408-251-9511
Practice Address - Street 1:2340 MCKEE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1615
Practice Address - Country:US
Practice Address - Phone:408-251-3750
Practice Address - Fax:408-251-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice