Provider Demographics
NPI:1083757157
Name:BAER, MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:BAER
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 1:2605 GUNPOWDER FARMS RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2205
Mailing Address - Country:US
Mailing Address - Phone:410-877-3567
Mailing Address - Fax:
Practice Address - Street 1:2106 FALLSTON RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1442
Practice Address - Country:US
Practice Address - Phone:410-893-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD172150ZA8QMedicare PIN