Provider Demographics
NPI:1467507921
Name:BAUMAN, JON CARL (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CARL
Last Name:BAUMAN
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 1:15 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2128
Mailing Address - Country:US
Mailing Address - Phone:303-659-1920
Mailing Address - Fax:303-659-9191
Practice Address - Street 1:15 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2128
Practice Address - Country:US
Practice Address - Phone:303-659-1920
Practice Address - Fax:303-659-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHDL-1041471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice