Provider Demographics
NPI:1619197027
Name:BACQUET, VICTORIA NISMAN (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NISMAN
Last Name:BACQUET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:V
Other - Last Name:NISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17214 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2103
Mailing Address - Country:US
Mailing Address - Phone:818-708-9889
Mailing Address - Fax:
Practice Address - Street 1:17214 SATICOY ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2103
Practice Address - Country:US
Practice Address - Phone:818-708-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice