Provider Demographics
NPI:1164687695
Name:BAHIA, AMRINDER P (DMD)
Entity Type:Individual
Prefix:
First Name:AMRINDER
Middle Name:P
Last Name:BAHIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 87TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9401
Mailing Address - Country:US
Mailing Address - Phone:253-678-1748
Mailing Address - Fax:
Practice Address - Street 1:1515 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1748
Practice Address - Country:US
Practice Address - Phone:360-740-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0000109961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice