Provider Demographics
NPI:1043391329
Name:BAUMGARTNER, MONTE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:L
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N HOLLADAY DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6924
Mailing Address - Country:US
Mailing Address - Phone:503-738-3368
Mailing Address - Fax:503-717-0388
Practice Address - Street 1:508 N HOLLADAY DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6924
Practice Address - Country:US
Practice Address - Phone:503-738-3368
Practice Address - Fax:503-717-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD55761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice