Provider Demographics
NPI:1588784458
Name:BACHOUR DENTAL CORPORATION
Entity type:Organization
Organization Name:BACHOUR DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUNZER
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-381-2005
Mailing Address - Street 1:3605 HOSPITAL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5173
Mailing Address - Country:US
Mailing Address - Phone:209-381-2005
Mailing Address - Fax:209-381-2036
Practice Address - Street 1:3605 HOSPITAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-381-2005
Practice Address - Fax:209-381-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92132-01OtherDENTI-CAL