Provider Demographics
NPI:1003265604
Name:MPIANA, BAMBI (DMD)
Entity Type:Individual
Prefix:DR
First Name:BAMBI
Middle Name:
Last Name:MPIANA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BAMBI
Other - Middle Name:
Other - Last Name:MBIYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1337 N MOUNTAIN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1134
Mailing Address - Country:US
Mailing Address - Phone:909-333-7451
Mailing Address - Fax:
Practice Address - Street 1:1337 N MOUNTAIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-333-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1023141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty