Provider Demographics
NPI:1275538191
Name:BAUGHMAN, DAVID GUNTER (DDS/MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GUNTER
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:DDS/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6011
Mailing Address - Country:US
Mailing Address - Phone:985-879-1972
Mailing Address - Fax:985-879-4661
Practice Address - Street 1:1608 POLK ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6011
Practice Address - Country:US
Practice Address - Phone:985-879-1972
Practice Address - Fax:985-879-4661
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0248901223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1850888Medicaid
LA4F207Medicare PIN
H86608Medicare UPIN
LA4F207CE01Medicare PIN