Provider Demographics
NPI:1275735821
Name:BACHOUR, MOUNZER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOUNZER
Middle Name:
Last Name:BACHOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MG
Other - Middle Name:
Other - Last Name:BACHOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:621 BOBWHITE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8352
Mailing Address - Country:US
Mailing Address - Phone:209-381-2005
Mailing Address - Fax:209-381-2036
Practice Address - Street 1:3605 HOSPITAL RD STE A
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist