MEDICARE: JENA BAUGH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0006626-C1	AL

General Provider Information

NPI Number	:	1568020402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENA BAUGH DMD

Provider Business Mailing Address
First Line	:	302 4TH ST SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-1840
Country	:	US
Telephone Number	:	256-845-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 4TH ST SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-1840
Country	:	US
Telephone Number	:	256-845-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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