Provider Demographics
NPI:1184956518
Name:PAUL M BAUMGARTNER DDS PC
Entity type:Organization
Organization Name:PAUL M BAUMGARTNER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-829-6879
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0417
Mailing Address - Country:US
Mailing Address - Phone:503-829-6879
Mailing Address - Fax:503-829-3398
Practice Address - Street 1:128 ROSS ST
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-9390
Practice Address - Country:US
Practice Address - Phone:503-829-6879
Practice Address - Fax:503-829-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5376261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental