Provider Demographics
NPI:1154311744
Name:BAUMGARDNER, DOUGLAS L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 SPORTSMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8222
Mailing Address - Country:US
Mailing Address - Phone:270-735-1787
Mailing Address - Fax:
Practice Address - Street 1:104 N WALTERS AVE
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1532
Practice Address - Country:US
Practice Address - Phone:270-358-3189
Practice Address - Fax:270-358-3180
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice