Provider Demographics
NPI:1861860975
Name:BACHOUR, OLGA (DDS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BACHOUR
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 1:621 BOBWHITE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8352
Mailing Address - Country:US
Mailing Address - Phone:209-381-2005
Mailing Address - Fax:209-381-2036
Practice Address - Street 1:3605 HOSPITAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-381-2005
Practice Address - Fax:209-381-2036
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice