Provider Demographics
NPI:1477767994
Name:BAWA, ANOOP S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANOOP
Middle Name:S
Last Name:BAWA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 BUCHANAN RD STE E
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4209
Mailing Address - Country:US
Mailing Address - Phone:925-757-6117
Mailing Address - Fax:925-757-6120
Practice Address - Street 1:2225 BUCHANAN RD STE E
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4209
Practice Address - Country:US
Practice Address - Phone:925-757-6117
Practice Address - Fax:925-757-6120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice