Provider Demographics
NPI:1013174556
Name:SCOTT W BAUMANN DDS PC
Entity Type:Organization
Organization Name:SCOTT W BAUMANN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-236-6174
Mailing Address - Street 1:902 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2050
Mailing Address - Country:US
Mailing Address - Phone:641-236-6174
Mailing Address - Fax:
Practice Address - Street 1:902 PARK ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2050
Practice Address - Country:US
Practice Address - Phone:641-236-6174
Practice Address - Fax:641-236-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA295731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232272Medicaid