Provider Demographics
NPI:1831296029
Name:GARY BAUMAN, DDS, PA
Entity Type:Organization
Organization Name:GARY BAUMAN, DDS, PA
Other - Org Name:BALTIMORE CENTER OF ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-296-5650
Mailing Address - Street 1:1134 YORK RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6215
Mailing Address - Country:US
Mailing Address - Phone:410-296-5650
Mailing Address - Fax:410-296-0354
Practice Address - Street 1:1134 YORK RD
Practice Address - Street 2:SUITE 213
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6215
Practice Address - Country:US
Practice Address - Phone:410-296-5650
Practice Address - Fax:410-296-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD98591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty