Provider Demographics
NPI:1649229865
Name:BAUM, BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:BAUM
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 1:15601 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2281
Mailing Address - Country:US
Mailing Address - Phone:313-272-3330
Mailing Address - Fax:313-272-3396
Practice Address - Street 1:15601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2281
Practice Address - Country:US
Practice Address - Phone:313-272-3330
Practice Address - Fax:313-272-3396
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI102991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice