Nina Bubalo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107926 Issued in CA

Practice address

306 Walnut Ave Ste 24
San Diego, CA 92103-4980

Phone

(619) 232-1005

NPI assigned

May 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bubalo Dental Corporation

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1649070061
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1992327456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 WALNUT AVE STE 24",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034980",
            "telephone_number": "619-232-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WALNUT AVE STE 24",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034980",
            "telephone_number": "619-232-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBALO",
        "first_name": "NINA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-07",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "E20969",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Bsharah
• Btla VI
• Julia Ting Bu, MD
• Patrick David Buan, P.A-C
• Bubalo Dental Corporation
• Malakai Jeremiah Buban
• Myra Sepulveda Buby, LCSW
• Richard L Buccigross, MD
• David E. Buccigrossi, MD
• Corey Jevon Buchanan

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.