Provider Demographics
NPI:1225293475
Name:MICHIEL, BASSAM (DDS)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:
Last Name:MICHIEL
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 1:515 N I ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3070
Mailing Address - Country:US
Mailing Address - Phone:559-673-2268
Mailing Address - Fax:559-673-2226
Practice Address - Street 1:515 N I ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3070
Practice Address - Country:US
Practice Address - Phone:559-673-2268
Practice Address - Fax:559-673-2226
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist