Provider Demographics
NPI:1013081355
Name:BAUER, DOUGLAS MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:BAUER
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 1:4640 NICOLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2306
Mailing Address - Country:US
Mailing Address - Phone:651-454-1414
Mailing Address - Fax:651-454-7987
Practice Address - Street 1:4640 NICOLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2306
Practice Address - Country:US
Practice Address - Phone:651-454-1414
Practice Address - Fax:651-454-7987
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist