Provider Demographics
NPI:1306923545
Name:BUGHAO, RODNEY JAY (DDS)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:JAY
Last Name:BUGHAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SUNCAST LANE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-941-0323
Mailing Address - Fax:916-941-0325
Practice Address - Street 1:1035 SUNCAST LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9658
Practice Address - Country:US
Practice Address - Phone:916-941-0323
Practice Address - Fax:916-941-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB355971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9401901Medicaid
CACGP162180OtherCCS PROVIDER ID