Provider Demographics
NPI:1801165279
Name:BAUM, BRADLEY JOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOEL
Last Name:BAUM
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-208-5678
Mailing Address - Fax:310-208-1968
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-208-5678
Practice Address - Fax:310-208-1968
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA279531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics