Provider Demographics
NPI:1295848638
Name:BAUM, SPENCER MORRIS (DDS)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:MORRIS
Last Name:BAUM
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 1:4508 E HWY 180
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067
Mailing Address - Country:US
Mailing Address - Phone:940-325-1788
Mailing Address - Fax:940-325-1400
Practice Address - Street 1:4508 E HWY 180
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067
Practice Address - Country:US
Practice Address - Phone:940-325-1788
Practice Address - Fax:940-325-1400
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist