Provider Demographics
NPI:1043212202
Name:BAETEN, LOU R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:R
Last Name:BAETEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12315 JUDSON RD., SUITE 218
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3264
Mailing Address - Country:US
Mailing Address - Phone:210-656-3531
Mailing Address - Fax:210-656-3532
Practice Address - Street 1:12315 JUDSON RD., SUITE 218
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-3264
Practice Address - Country:US
Practice Address - Phone:210-656-3531
Practice Address - Fax:210-656-3532
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics