Provider Demographics
NPI:1104333426
Name:BAHAMON, CARLOS (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:BAHAMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:BAHAMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1625 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-4931
Mailing Address - Country:US
Mailing Address - Phone:661-398-1744
Mailing Address - Fax:
Practice Address - Street 1:1625 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4931
Practice Address - Country:US
Practice Address - Phone:661-398-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist