Provider Demographics
NPI:1548275100
Name:BAUER, FREDERICK SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:BAUER
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 1:611 ALCORN DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9321
Mailing Address - Country:US
Mailing Address - Phone:662-287-8299
Mailing Address - Fax:662-286-8789
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:SUITE 220
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-287-8299
Practice Address - Fax:662-286-8789
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS2330-871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660372Medicaid
MS00660372Medicaid