Provider Demographics
NPI:1447602784
Name:BAUERLE SYNDERGAARD PERIODONTICS,PLLC
Entity Type:Organization
Organization Name:BAUERLE SYNDERGAARD PERIODONTICS,PLLC
Other - Org Name:CARSON PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-882-3033
Mailing Address - Street 1:1675 VISTA LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4640
Mailing Address - Country:US
Mailing Address - Phone:775-882-3033
Mailing Address - Fax:775-882-4449
Practice Address - Street 1:1675 VISTA LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4640
Practice Address - Country:US
Practice Address - Phone:775-882-3033
Practice Address - Fax:775-882-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty