Provider Demographics
NPI:1598846081
Name:BAUMGARDNER, MARTIN LEE (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:LEE
Last Name:BAUMGARDNER
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 1:506 W PAIGE AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-753-8855
Mailing Address - Fax:330-753-4530
Practice Address - Street 1:506 W PAIGE AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-753-8855
Practice Address - Fax:330-753-4530
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist