Provider Demographics
NPI:1205387446
Name:BACHMAN, FABIOLA (DDS)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N PASS AVE
Mailing Address - Street 2:2
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4242
Mailing Address - Country:US
Mailing Address - Phone:925-980-1391
Mailing Address - Fax:
Practice Address - Street 1:138 N PASS AVE
Practice Address - Street 2:2
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:925-980-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist