Provider Demographics
NPI:1669616553
Name:BAUM, BRUCE JAY (DMD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAY
Last Name:BAUM
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MPTB NIDCR NIH
Mailing Address - Street 2:BLDG. 10, RM. 1N113, MSC-1190
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-496-1363
Mailing Address - Fax:301-402-1228
Practice Address - Street 1:MPTB NIDCR NIH
Practice Address - Street 2:BLDG. 10, RM. 1N113, MSC-1190
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-1363
Practice Address - Fax:301-402-1228
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist