Provider Demographics
NPI:1609543560
Name:BACOL, SINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SINA
Middle Name:
Last Name:BACOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 MAINWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4818
Mailing Address - Country:US
Mailing Address - Phone:562-685-5446
Mailing Address - Fax:
Practice Address - Street 1:3252 MAINWAY DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4818
Practice Address - Country:US
Practice Address - Phone:562-685-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist