Provider Demographics
NPI:1548305733
Name:BAUER, PAUL M (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
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 1:141 DUNNING RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2214
Mailing Address - Country:US
Mailing Address - Phone:845-342-2550
Mailing Address - Fax:845-343-2776
Practice Address - Street 1:141 DUNNING RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2214
Practice Address - Country:US
Practice Address - Phone:845-342-2550
Practice Address - Fax:845-343-2776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0294761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00526045Medicaid