Provider Demographics
NPI:1609321199
Name:BACHOUR, MAXIME (DDS)
Entity Type:Individual
Prefix:
First Name:MAXIME
Middle Name:
Last Name:BACHOUR
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 1:1941 HUNTINGTON DR STE H
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4995
Mailing Address - Country:US
Mailing Address - Phone:626-658-7882
Mailing Address - Fax:626-658-7882
Practice Address - Street 1:1941 HUNTINGTON DR STE H
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4995
Practice Address - Country:US
Practice Address - Phone:626-685-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100739122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist