Individual
DR. GUS BAHOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1115 AZALEA PL, BREWTON, AL 36426-1318
(251) 809-3925
(251) 809-6058
Mailing address
PO BOX 726, EVERGREEN, AL 36401-0726
(251) 578-1163
(251) 578-9875
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3823
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130949
—
AL
01
—
511-19195
BLUE CROSS BLUE SHIELD
AL
Enumeration date
12/01/2006
Last updated
05/15/2013
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