Provider Demographics
NPI:1427277342
Name:BAMBICO, MICHAEL ORAN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ORAN
Last Name:BAMBICO
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 1:4177 HIDDEN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2530
Mailing Address - Country:US
Mailing Address - Phone:408-923-3850
Mailing Address - Fax:408-347-1695
Practice Address - Street 1:150 N JACKSON AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1908
Practice Address - Country:US
Practice Address - Phone:408-259-1004
Practice Address - Fax:408-347-1695
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
263428495OtherCORP FEIN
CA35576032OtherEMPLOYER STATE ID
263428495OtherCORP FEIN