Provider Demographics
NPI:1851487177
Name:BAUS, BRADLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:BAUS
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 1:1836 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HOLSTEIN
Mailing Address - State:WI
Mailing Address - Zip Code:53061
Mailing Address - Country:US
Mailing Address - Phone:920-898-5626
Mailing Address - Fax:920-898-5626
Practice Address - Street 1:1836 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:NEW HOLSTEIN
Practice Address - State:WI
Practice Address - Zip Code:53061
Practice Address - Country:US
Practice Address - Phone:920-898-5626
Practice Address - Fax:920-898-5626
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist