Provider Demographics
NPI:1710774492
Name:BASSAM EKRAM MICHIEL DDS INC
Entity type:Organization
Organization Name:BASSAM EKRAM MICHIEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:EKRAM
Authorized Official - Last Name:MICHIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-673-2268
Mailing Address - Street 1:515 N I ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3070
Mailing Address - Country:US
Mailing Address - Phone:559-673-2268
Mailing Address - Fax:559-673-2226
Practice Address - Street 1:515 N I ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3070
Practice Address - Country:US
Practice Address - Phone:559-673-2268
Practice Address - Fax:559-673-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty