Provider Demographics
NPI:1447319496
Name:BAFUS, PAIGE THERESA (DDS)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:THERESA
Last Name:BAFUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HIGHWAY 95
Mailing Address - Street 2:STE 112
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4334
Mailing Address - Country:US
Mailing Address - Phone:928-758-0008
Mailing Address - Fax:928-758-0009
Practice Address - Street 1:3015 HIGHWAY 95
Practice Address - Street 2:SUITE 112
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-758-0008
Practice Address - Fax:928-758-0009
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5419122300000X
AZD7722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510499Medicaid