Provider Demographics
NPI:1427771104
Name:BAJWA, HIBBA ZIA
Entity type:Individual
Prefix:
First Name:HIBBA
Middle Name:ZIA
Last Name:BAJWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 CATAMOUNT CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3311
Mailing Address - Country:US
Mailing Address - Phone:702-978-0626
Mailing Address - Fax:
Practice Address - Street 1:3635 N FREEWAY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2926
Practice Address - Country:US
Practice Address - Phone:916-285-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV77251223G0001X
CADDS108595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice