Provider Demographics
NPI:1154320257
Name:BAUER, GERALD ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALLEN
Last Name:BAUER
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 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 309 BDG. D
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-988-6767
Mailing Address - Fax:303-988-4518
Practice Address - Street 1:3333 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 309 BDG. D
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5122
Practice Address - Country:US
Practice Address - Phone:303-988-6767
Practice Address - Fax:303-988-4518
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice