Provider Demographics
NPI:1295702207
Name:BAUMGARDNER, RAYMOND MARTIN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MARTIN
Last Name:BAUMGARDNER
Suffix:JR
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 1:2208 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5221
Mailing Address - Country:US
Mailing Address - Phone:870-862-2182
Mailing Address - Fax:
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5634
Practice Address - Country:US
Practice Address - Phone:870-863-8161
Practice Address - Fax:870-863-8356
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAB1450321OtherFEDERAL DEA CERTIFICATE