Provider Demographics
NPI:1043408883
Name:JAY E. BAUMAN D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:JAY E. BAUMAN D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-532-0888
Mailing Address - Street 1:1110 E CHAPMAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2145
Mailing Address - Country:US
Mailing Address - Phone:714-532-0888
Mailing Address - Fax:714-532-0066
Practice Address - Street 1:1110 E CHAPMAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2145
Practice Address - Country:US
Practice Address - Phone:714-532-0888
Practice Address - Fax:714-532-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38491261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental