Provider Demographics
NPI:1255419677
Name:BAUSBACK, NATALIA M (DMD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:M
Last Name:BAUSBACK
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 1:32 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-3646
Mailing Address - Country:US
Mailing Address - Phone:518-439-8515
Mailing Address - Fax:
Practice Address - Street 1:324 N GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8518
Practice Address - Country:US
Practice Address - Phone:518-286-5354
Practice Address - Fax:518-286-5601
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04760411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice