Provider Demographics
NPI:1669457412
Name:BACHAS, TED LOUIS (DDS)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:LOUIS
Last Name:BACHAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 TOWNPOINT RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2754
Mailing Address - Country:US
Mailing Address - Phone:757-483-6155
Mailing Address - Fax:757-483-6175
Practice Address - Street 1:6550 TOWNPOINT RD
Practice Address - Street 2:STE 105
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2754
Practice Address - Country:US
Practice Address - Phone:757-483-6155
Practice Address - Fax:757-483-6175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist