Provider Demographics
NPI:1205529922
Name:BAUSERMAN, BO (DDS)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:BAUSERMAN
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 1:99 ROSEMAR RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-7657
Mailing Address - Country:US
Mailing Address - Phone:304-878-7189
Mailing Address - Fax:
Practice Address - Street 1:99 ROSEMAR RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7657
Practice Address - Country:US
Practice Address - Phone:304-878-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027206122300000X
WV4630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist