Provider Demographics
NPI:1720127962
Name:BACA, NORMA A (DDS)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:A
Last Name:BACA
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 1:1919 BEVERLY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2401
Mailing Address - Country:US
Mailing Address - Phone:213-484-2165
Mailing Address - Fax:213-484-0162
Practice Address - Street 1:1919 BEVERLY BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2401
Practice Address - Country:US
Practice Address - Phone:213-484-2165
Practice Address - Fax:213-484-0162
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice