Provider Demographics
NPI:1093710204
Name:BAUS, MICHAEL F (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:BAUS
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 1:1724 BEALL AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2344
Mailing Address - Country:US
Mailing Address - Phone:330-264-2249
Mailing Address - Fax:
Practice Address - Street 1:1724 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2344
Practice Address - Country:US
Practice Address - Phone:330-264-2249
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
OH30-01-65181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice