Provider Demographics
NPI:1972897627
Name:BAUMAN, GREGORY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWARD
Last Name:BAUMAN
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 1:8383 M 139
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9001
Mailing Address - Country:US
Mailing Address - Phone:269-471-4055
Mailing Address - Fax:269-471-3829
Practice Address - Street 1:8383 M 139
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9001
Practice Address - Country:US
Practice Address - Phone:269-471-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901020416OtherSTATE OF MICHIGAN DENTAL LICENSE