Provider Demographics
NPI:1821181835
Name:BAUMBAUER, JON M (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:BAUMBAUER
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 1:751 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-3101
Mailing Address - Country:US
Mailing Address - Phone:386-428-6491
Mailing Address - Fax:
Practice Address - Street 1:1329 E TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5107
Practice Address - Country:US
Practice Address - Phone:850-878-7999
Practice Address - Fax:850-942-2681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN70841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice