Provider Demographics
NPI:1689779605
Name:BRAD L. BAUER, DMD, PA, INC
Entity Type:Organization
Organization Name:BRAD L. BAUER, DMD, PA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:LOUDEN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-856-5711
Mailing Address - Street 1:8096 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-856-5711
Mailing Address - Fax:330-856-7685
Practice Address - Street 1:8096 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-856-5711
Practice Address - Fax:330-856-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300220501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty