Provider Demographics
NPI:1952329179
Name:BACHHUBER, THOMAS EDWARD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:BACHHUBER
Suffix:JR
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 1:2236 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7696
Mailing Address - Country:US
Mailing Address - Phone:503-654-6529
Mailing Address - Fax:503-654-3976
Practice Address - Street 1:2236 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7696
Practice Address - Country:US
Practice Address - Phone:503-654-6529
Practice Address - Fax:503-654-3976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice