Provider Demographics
NPI:1013062728
Name:BAUMANN, JON CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:CHARLES
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JON
Other - Middle Name:C
Other - Last Name:BAUMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:809 BELFAST ST
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3324
Mailing Address - Country:US
Mailing Address - Phone:605-665-5695
Mailing Address - Fax:605-260-5695
Practice Address - Street 1:809 BELFAST ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3324
Practice Address - Country:US
Practice Address - Phone:605-665-5695
Practice Address - Fax:605-260-5695
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7805010Medicaid
NE46046350400Medicaid