Provider Demographics
NPI:1245251651
Name:BAUMAN, IRA BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:BRIAN
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E. FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-3865
Mailing Address - Fax:732-264-3631
Practice Address - Street 1:7 E. FRONT ST.
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1524
Practice Address - Country:US
Practice Address - Phone:732-264-3865
Practice Address - Fax:732-264-3631
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice