Provider Demographics
NPI:1245218544
Name:BAUR, DALE A (DDS)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:BAUR
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:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-0415
Mailing Address - Country:US
Mailing Address - Phone:440-729-3399
Mailing Address - Fax:440-729-6001
Practice Address - Street 1:9601 CHESTER AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1666
Practice Address - Country:US
Practice Address - Phone:212-368-3102
Practice Address - Fax:216-368-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-017004122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0526103Medicaid