Provider Demographics
NPI:1205866050
Name:BAUER, JEFF CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:CHARLES
Last Name:BAUER
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 1:226 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3705
Mailing Address - Country:US
Mailing Address - Phone:978-744-2480
Mailing Address - Fax:978-744-2408
Practice Address - Street 1:226 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3705
Practice Address - Country:US
Practice Address - Phone:978-744-2480
Practice Address - Fax:978-744-2408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice