Provider Demographics
NPI:1902988488
Name:BAUER, JAY ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ALLEN
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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-0139
Mailing Address - Country:US
Mailing Address - Phone:701-652-2801
Mailing Address - Fax:701-652-2802
Practice Address - Street 1:923 1ST STREET SOUTH
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-0139
Practice Address - Country:US
Practice Address - Phone:701-652-2801
Practice Address - Fax:701-652-2802
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND040949Medicaid