Provider Demographics
NPI:1619041969
Name:DOUGLAS M BAUER DDS,PA
Entity Type:Organization
Organization Name:DOUGLAS M BAUER DDS,PA
Other - Org Name:OAK CLIFF DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-454-1414
Mailing Address - Street 1:4640 NICOLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2306
Mailing Address - Country:US
Mailing Address - Phone:651-454-1414
Mailing Address - Fax:651-454-7987
Practice Address - Street 1:4640 NICOLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2306
Practice Address - Country:US
Practice Address - Phone:651-454-1414
Practice Address - Fax:651-454-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty