Provider Demographics
NPI:1356649347
Name:JAY A BAUER DDS PC
Entity Type:Organization
Organization Name:JAY A BAUER DDS PC
Other - Org Name:CARRINGTON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-652-2801
Mailing Address - Street 1:923 1ST STREET S
Mailing Address - Street 2:PO BOX 139
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-0139
Mailing Address - Country:US
Mailing Address - Phone:701-652-2801
Mailing Address - Fax:701-652-2802
Practice Address - Street 1:923 1ST ST S
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2034
Practice Address - Country:US
Practice Address - Phone:701-652-2801
Practice Address - Fax:701-652-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty