Provider Demographics
NPI:1003893249
Name:BAUS, MARK RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:BAUS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1 JARRETT WHITE ROAD
Mailing Address - Street 2:ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-1021
Mailing Address - Fax:808-433-3928
Practice Address - Street 1:1 JARRETT WHITE ROAD
Practice Address - Street 2:ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-1021
Practice Address - Fax:808-433-3928
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3807-0151223S0112X
CO69311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery