Provider Demographics
NPI:1558850487
Name:BAUSERMAN, LUKE ALMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ALMA
Last Name:BAUSERMAN
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 1:319 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9558
Mailing Address - Country:US
Mailing Address - Phone:740-374-7060
Mailing Address - Fax:740-374-0023
Practice Address - Street 1:99 ROSEMAR RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7657
Practice Address - Country:US
Practice Address - Phone:304-424-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025371122300000X, 1223G0001X
WV4320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice