Provider Demographics
NPI:1679618524
Name:BAUDER, ROBERT J (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BAUDER
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36275 KENAI SPUR HWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7106
Mailing Address - Country:US
Mailing Address - Phone:907-262-8404
Mailing Address - Fax:907-262-9442
Practice Address - Street 1:36275 KENAI SPUR HWY
Practice Address - Street 2:SUITE #1
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7106
Practice Address - Country:US
Practice Address - Phone:907-262-8404
Practice Address - Fax:907-262-9442
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice