MEDICARE: DR. STEPHEN CHRISTIAN BAHM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9757	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9757	OTHER	TX	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1346453354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN CHRISTIAN BAHM DDS

Provider Business Mailing Address
First Line	:	1011 AUGUSTA DR
Second Line	:	#100
City	:	HOUSTON
State	:	TX
Zip	:	77057-2062
Country	:	US
Telephone Number	:	713-622-3240
Fax Number	:	713-622-3280

Provider Business Practice Location Address
First Line	:	1011 AUGUSTA DR
Second Line	:	#100
City	:	HOUSTON
State	:	TX
Zip	:	77057-2062
Country	:	US
Telephone Number	:	713-622-3240
Fax Number	:	713-622-3280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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