Provider Demographics
NPI:1831477819
Name:BAUERLE, JARED (DMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BAUERLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4702
Mailing Address - Country:US
Mailing Address - Phone:575-522-2477
Mailing Address - Fax:
Practice Address - Street 1:2918 HILLRISE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4702
Practice Address - Country:US
Practice Address - Phone:575-522-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5871 C11223G0001X
NMDD3986122300000X, 1223P0300X
TX29230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist