Healthcare Provider Details

I. General information

NPI: 1013049634
Provider Name (Legal Business Name): ANDREA LOU BAUMANN DDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W BOND AVE
WEST MEMPHIS AR
72301-3909
US

IV. Provider business mailing address

460 TENNESSEE ST APT 301
MEMPHIS TN
38103-4484
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-7805
  • Fax: 870-735-7853
Mailing address:
  • Phone: 951-533-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDT034816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: