Provider Demographics
NPI:1326092966
Name:BAUER, GEORGE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:BAUER
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 1:688 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-4303
Mailing Address - Country:US
Mailing Address - Phone:814-266-6820
Mailing Address - Fax:
Practice Address - Street 1:670 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3246
Practice Address - Country:US
Practice Address - Phone:814-255-4134
Practice Address - Fax:814-255-4135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021264L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005398530002OtherSTATE MEDICAL ASSISTANCE
PABA098629OtherPA BLUE CROSS BLUE SHIELD