Provider Demographics
NPI:1447904834
Name:ABOUBAKARE, BIANCA (DMD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:ABOUBAKARE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 TEHAMA ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4374
Mailing Address - Country:US
Mailing Address - Phone:714-264-4156
Mailing Address - Fax:
Practice Address - Street 1:2549 E MUIRFIELD ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0023
Practice Address - Country:US
Practice Address - Phone:714-264-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105692122300000X, 1223E0200X
AZ0115861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist