Provider Demographics
NPI:1710050505
Name:BAUM, IRVING (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRVING
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 1:225 ROUTE 82 MARKS PLAZA
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:845-897-9698
Mailing Address - Fax:845-897-3384
Practice Address - Street 1:225 ROUTE 82 MARKS PLAZA
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-897-9698
Practice Address - Fax:845-897-3384
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0243561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice