Provider Demographics
NPI:1811180185
Name:BAUER, SARA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:MICHELLE
Last Name:BAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 S LONE PINE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2610
Mailing Address - Country:US
Mailing Address - Phone:417-883-2223
Mailing Address - Fax:471-881-6842
Practice Address - Street 1:1824 S LONE PINE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2610
Practice Address - Country:US
Practice Address - Phone:417-883-2223
Practice Address - Fax:471-881-6842
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070253041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice