Miguel Ismael Bustamante, DDS
Individual provider Active NPI General Practice Dentistry · Bolinas, CA
NPI 1194160341 · NPPES record last updated May 1, 2013
Key facts
- NPI
- 1194160341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 034821 (CA)
- Practice address
- 24 Wharf Road
Bolinas, CA 94924 - Phone
- (415) 868-0911
- Fax
- (415) 868-2324
- NPI assigned
- May 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034821 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 034821 | CA | Yes |
Addresses
Primary practice location
24 Wharf Road
Bolinas, CA 94924
Mailing address
PO Box 975
Bolinas, CA 94924-0975
Phone (415) 868-0911
Other providers in Bolinas, CA
- Media Leones Aranda Medcroft
- Bryan Ivan Barientos
- Patricia Anne Bradford
- Abigail Emily Fairlie Bruce
- Coastal Health Alliance
- Liliya Danilyan
- Ilene Raisefeld Danse
- Meadow Evans
- Camilla Anne Ford
All providers in Bolinas, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.