Maxime Bachour, D.D.S.
Individual provider Active NPI Endodontics · South Pasadena, CA
NPI 1609321199 · NPPES record last updated Sep 21, 2023
Key facts
- NPI
- 1609321199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 100739 (CA)
- Practice address
- 1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995 - Phone
- (626) 685-7882
- NPI assigned
- Aug 24, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| 100739 | CA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bachour-Lu Dental Corporation | Endodontics | Past |
Accepting new patients |
| Bachour Dental Corporation | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 100739 | CA | |
| Endodontics | 1223E0200X | 100739 | CA | Yes |
Addresses
Primary practice location
1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995
Mailing address
1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995
Phone (626) 658-7882
Other providers in South Pasadena, CA
- Alice Avedikian
- Vanessa Annettie Franklin Axelrod
- Luz Ayon
- Monica Babaian
- Bachour-Lu Dental Corporation
- Andrea Dawn Bailey
- Baj Management, Inc.
- Matthew Douglass Baldwin
- Daria Balling
- Emily Baltazar
All providers in South Pasadena, CA · Endodontics in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2023. 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.