Provider Demographics
NPI:1952402067
Name:BAHROOS, JUNITA (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:JUNITA
Middle Name:
Last Name:BAHROOS
Suffix:
Gender:F
Credentials:DDS,PC
Other - Prefix:MRS
Other - First Name:JUNITA
Other - Middle Name:
Other - Last Name:ROETHLISBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19865 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1021
Mailing Address - Country:US
Mailing Address - Phone:734-479-2200
Mailing Address - Fax:734-479-2202
Practice Address - Street 1:19865 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1021
Practice Address - Country:US
Practice Address - Phone:734-479-2200
Practice Address - Fax:734-479-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI159191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice