Provider Demographics
NPI:1639199623
Name:BAUM, RICHARD S (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:BAUM
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:PO BOX 317
Mailing Address - Street 2:26 CHURCH STREET
Mailing Address - City:LIBERTY CORNER
Mailing Address - State:NJ
Mailing Address - Zip Code:07938-0317
Mailing Address - Country:US
Mailing Address - Phone:908-580-1060
Mailing Address - Fax:908-580-9767
Practice Address - Street 1:26 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY CORNER
Practice Address - State:NJ
Practice Address - Zip Code:07938-0317
Practice Address - Country:US
Practice Address - Phone:908-580-1060
Practice Address - Fax:908-580-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ173341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice