Provider Demographics
NPI:1851501084
Name:BAUMGARDNER, WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BAUMGARDNER
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 1:1008 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2741
Mailing Address - Country:US
Mailing Address - Phone:608-783-3341
Mailing Address - Fax:608-783-4309
Practice Address - Street 1:1008 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2741
Practice Address - Country:US
Practice Address - Phone:608-783-3341
Practice Address - Fax:608-783-4309
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0500G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist