Provider Demographics
NPI:1477625937
Name:BAUM, DOUGLAS PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:BAUM
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 1:9240 ANDERMATT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9761
Mailing Address - Country:US
Mailing Address - Phone:402-486-4050
Mailing Address - Fax:402-486-4051
Practice Address - Street 1:9240 ANDERMATT DR STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9761
Practice Address - Country:US
Practice Address - Phone:402-486-4050
Practice Address - Fax:402-486-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025063900Medicaid
NE08348OtherBLUE CROSS BLUE SHIELD
NE885174OtherUNITED CONCORDIA MILITARY