Provider Demographics
NPI:1457401705
Name:BAUMGARTNER, JOE ALLEN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:ALLEN
Last Name:BAUMGARTNER
Suffix:I
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 1:1001 N MAIN ST
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1016
Mailing Address - Country:US
Mailing Address - Phone:574-773-7979
Mailing Address - Fax:574-773-7292
Practice Address - Street 1:1001 N MAIN ST
Practice Address - Street 2:SUITE TWO
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1016
Practice Address - Country:US
Practice Address - Phone:574-773-7979
Practice Address - Fax:574-773-7292
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007757A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice