Provider Demographics
NPI:1407098460
Name:BAKDACH, IYAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:IYAD
Middle Name:
Last Name:BAKDACH
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 1:1040 GRANT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3200
Mailing Address - Country:US
Mailing Address - Phone:650-314-0100
Mailing Address - Fax:
Practice Address - Street 1:1040 GRANT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3200
Practice Address - Country:US
Practice Address - Phone:650-314-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty