1447319496 NPI number — DR. PAIGE THERESA BAFUS DDS

Table of content: DR. PAIGE THERESA BAFUS DDS (NPI 1447319496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447319496 NPI number — DR. PAIGE THERESA BAFUS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAFUS
Provider First Name:
PAIGE
Provider Middle Name:
THERESA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447319496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3015 HIGHWAY 95
Provider Second Line Business Mailing Address:
STE 112
Provider Business Mailing Address City Name:
BULLHEAD CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86442-4334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-758-0008
Provider Business Mailing Address Fax Number:
928-758-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 HIGHWAY 95
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-758-0008
Provider Business Practice Location Address Fax Number:
928-758-0009
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5419 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: D7722 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100510499 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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