Provider Demographics
NPI:1548379118
Name:BAETHGE, JERRY PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:PAUL
Last Name:BAETHGE
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 1:4907 SANDHILL DR
Mailing Address - Street 2:SUITE #C
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-565-8822
Mailing Address - Fax:281-565-8901
Practice Address - Street 1:4907 SANDHILL DR
Practice Address - Street 2:SUITE #C
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-565-8822
Practice Address - Fax:281-565-8901
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX13239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist