Provider Demographics
NPI:1427294289
Name:CHARLES D. BAUER, D.D.S., P.C.
Entity type:Organization
Organization Name:CHARLES D. BAUER, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-6410
Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2615
Mailing Address - Country:US
Mailing Address - Phone:402-462-6410
Mailing Address - Fax:402-462-4463
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2615
Practice Address - Country:US
Practice Address - Phone:402-462-6410
Practice Address - Fax:402-462-4463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES D. BAUER, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-29
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194739276OtherNPI