Healthcare Provider Details

I. General information

NPI: 1821211715
Provider Name (Legal Business Name): DOUGLAS DURAND BAUM DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14772 PLAZA DR STE 100
TUSTIN CA
92780-2798
US

IV. Provider business mailing address

14772 PLAZA DR STE 100
TUSTIN CA
92780-2798
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-8030
  • Fax:
Mailing address:
  • Phone: 714-544-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number48429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: