MEDICARE: DR. CHRISTOPHER L. BAHARA D.M.D.

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	1223G0001X	General Practice Dentistry	DS-029772-L	PA

General Provider Information

NPI Number	:	1437179579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER L. BAHARA D.M.D.

Provider Business Mailing Address
First Line	:	447 MANORVIEW AVE
Second Line	:
City	:	MOUNT POCONO
State	:	PA
Zip	:	18344-1303
Country	:	US
Telephone Number	:	570-839-9453
Fax Number	:	570-421-1025

Provider Business Practice Location Address
First Line	:	447 MANORVIEW AVE
Second Line	:
City	:	MOUNT POCONO
State	:	PA
Zip	:	18344-1303
Country	:	US
Telephone Number	:	570-839-9453
Fax Number	:	570-421-1025

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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