Provider Demographics
NPI:1023793650
Name:BAUER, JOANNA (DMD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 KENT RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-6756
Mailing Address - Country:US
Mailing Address - Phone:843-833-2606
Mailing Address - Fax:
Practice Address - Street 1:108 BURTON ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5400
Practice Address - Country:US
Practice Address - Phone:864-576-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice