Provider Demographics
NPI:1912919432
Name:BAHLINGER, PAUL VERNON (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:VERNON
Last Name:BAHLINGER
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 1:55 CATHEDRAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8630
Mailing Address - Country:US
Mailing Address - Phone:719-475-7946
Mailing Address - Fax:
Practice Address - Street 1:51 S BRIAN MICKELSEN PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3610
Practice Address - Country:US
Practice Address - Phone:928-639-8132
Practice Address - Fax:866-274-8919
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD091821223G0001X
CO98851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1196541Medicaid