Healthcare Provider Details

I. General information

NPI: 1548904170
Provider Name (Legal Business Name): VIORELA BAUER DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 200
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

850 FAIR OAKS AVE STE 200
ARROYO GRANDE CA
93420-3929
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-6617
  • Fax: 805-666-2559
Mailing address:
  • Phone: 805-481-6617
  • Fax: 805-666-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIORELA BAUER GOODALE
Title or Position: OWNER
Credential: DDS
Phone: 805-481-6617