Provider Demographics
NPI:1003141722
Name:BAUER, MATTHEW J (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:BAUER
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Gender:M
Credentials:DMD MS
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Mailing Address - Street 1:150 WEISS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376-0045
Mailing Address - Country:US
Mailing Address - Phone:636-447-2083
Mailing Address - Fax:636-447-2059
Practice Address - Street 1:150 WEISS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-0045
Practice Address - Country:US
Practice Address - Phone:636-447-2083
Practice Address - Fax:636-447-2059
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2011-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20110043621223X0400X
IL0190269331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics