Provider Demographics
NPI:1780081083
Name:BAUS, MICHAEL STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:BAUS
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 1:15 E MAIN ST
Mailing Address - Street 2:PO 71
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1427
Mailing Address - Country:US
Mailing Address - Phone:920-849-9341
Mailing Address - Fax:
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:PO 71
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1427
Practice Address - Country:US
Practice Address - Phone:920-849-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001454-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice