Provider Demographics
NPI:1790984680
Name:BAER, JENIFFER LOUISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENIFFER
Middle Name:LOUISE
Last Name:BAER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2111
Mailing Address - Country:US
Mailing Address - Phone:860-450-9237
Mailing Address - Fax:860-450-9274
Practice Address - Street 1:1003 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2111
Practice Address - Country:US
Practice Address - Phone:860-450-9237
Practice Address - Fax:860-450-9274
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT008628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist