Provider Demographics
NPI:1437218443
Name:MICHAEL S BAUS DDS SC
Entity Type:Organization
Organization Name:MICHAEL S BAUS DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-849-9341
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1427
Mailing Address - Country:US
Mailing Address - Phone:920-849-9341
Mailing Address - Fax:920-849-9342
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1427
Practice Address - Country:US
Practice Address - Phone:920-849-9341
Practice Address - Fax:920-849-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001454-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty