Provider Demographics
NPI:1891069944
Name:JEFFREY C BAUER DMD, PC
Entity Type:Organization
Organization Name:JEFFREY C BAUER DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-757-2222
Mailing Address - Street 1:19 PROMENADE ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7037
Mailing Address - Country:US
Mailing Address - Phone:843-757-2222
Mailing Address - Fax:
Practice Address - Street 1:19 PROMENADE ST
Practice Address - Street 2:UNIT 201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7037
Practice Address - Country:US
Practice Address - Phone:843-757-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD4574GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty