Provider Demographics
NPI:1902928591
Name:BAUER, JON FENTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:FENTON
Last Name:BAUER
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 1:5670 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5679
Mailing Address - Country:US
Mailing Address - Phone:323-933-1990
Mailing Address - Fax:323-933-4990
Practice Address - Street 1:5670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5679
Practice Address - Country:US
Practice Address - Phone:323-933-1990
Practice Address - Fax:323-933-4990
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice