Provider Demographics
NPI:1477860716
Name:REYNOLD J. BAUMSTARK DDS
Entity Type:Organization
Organization Name:REYNOLD J. BAUMSTARK DDS
Other - Org Name:REYNOLD J BAUMSTARK, D.D.S., PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BAUMSTARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-793-0353
Mailing Address - Street 1:5605 COLONY DR N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5718
Mailing Address - Country:US
Mailing Address - Phone:989-793-0353
Mailing Address - Fax:
Practice Address - Street 1:5605 COLONY DR N
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5718
Practice Address - Country:US
Practice Address - Phone:989-793-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010103901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty