Provider Demographics
NPI:1033378120
Name:WILLIAM H BAUSCH DDS PC
Entity Type:Organization
Organization Name:WILLIAM H BAUSCH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-355-7488
Mailing Address - Street 1:3575 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2292
Mailing Address - Country:US
Mailing Address - Phone:563-355-7488
Mailing Address - Fax:563-355-7003
Practice Address - Street 1:3575 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2292
Practice Address - Country:US
Practice Address - Phone:563-355-7488
Practice Address - Fax:563-355-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6623261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental