Provider Demographics
NPI:1790392298
Name:UM, BO RAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BO RAM
Middle Name:
Last Name:UM
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 1:1191 E EL MONTE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1731
Mailing Address - Country:US
Mailing Address - Phone:559-591-4320
Mailing Address - Fax:559-591-1494
Practice Address - Street 1:1191 E EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1731
Practice Address - Country:US
Practice Address - Phone:559-591-4320
Practice Address - Fax:559-591-1494
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1049811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice