Provider Demographics
NPI:1609975135
Name:BAUER, JOSEPH LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:BAUER
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 1:613 STRAWBERRY VLG
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2334
Mailing Address - Country:US
Mailing Address - Phone:415-380-3600
Mailing Address - Fax:
Practice Address - Street 1:613 STRAWBERRY VLG
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2334
Practice Address - Country:US
Practice Address - Phone:415-380-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist