Provider Demographics
NPI:1831312735
Name:BAER, DAVID LYLE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LYLE
Last Name:BAER
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 1:422 N BENTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46543-9732
Mailing Address - Country:US
Mailing Address - Phone:574-642-4449
Mailing Address - Fax:
Practice Address - Street 1:422 N BENTON ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:46543-9732
Practice Address - Country:US
Practice Address - Phone:574-642-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice