Provider Demographics
NPI:1639168859
Name:BAUMANN, DONALD THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 WESLEYAN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-4038
Mailing Address - Country:US
Mailing Address - Phone:502-423-8624
Mailing Address - Fax:
Practice Address - Street 1:4007 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4221
Practice Address - Country:US
Practice Address - Phone:502-448-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY51311223G0001X
KY5131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist