Provider Demographics
NPI:1649885815
Name:ISHAYA, BRONEIL (DDS)
Entity type:Individual
Prefix:
First Name:BRONEIL
Middle Name:
Last Name:ISHAYA
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 1:690 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0547
Mailing Address - Country:US
Mailing Address - Phone:209-277-0981
Mailing Address - Fax:
Practice Address - Street 1:3950 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1147
Practice Address - Country:US
Practice Address - Phone:209-277-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105491122300000X
CA105492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist