MEDICARE: DR. CARLY PAIGE BACHUS 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	1223G0001X	General Practice Dentistry	2901601791	MI

General Provider Information

NPI Number	:	1932881513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLY PAIGE BACHUS DDS

Provider Business Mailing Address
First Line	:	2911 W GRAND BLVD APT 2136
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2645
Country	:	US
Telephone Number	:	647-308-9454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 W GRAND BLVD APT 2136
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2645
Country	:	US
Telephone Number	:	647-308-9454
Fax Number	:

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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