Provider Demographics
NPI:1164574729
Name:BAUER, PETER JEFFREY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JEFFREY
Last Name:BAUER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13035 POMERADO RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4247
Mailing Address - Country:US
Mailing Address - Phone:858-486-1412
Mailing Address - Fax:858-486-2289
Practice Address - Street 1:13035 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4247
Practice Address - Country:US
Practice Address - Phone:858-486-1412
Practice Address - Fax:858-486-2289
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics