Provider Demographics
NPI:1477703460
Name:BAER, AUDREY LYNN (CDA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:BAER
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:FOREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDA
Mailing Address - Street 1:561 STONE SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7165
Mailing Address - Country:US
Mailing Address - Phone:614-866-7694
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-257-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant