Healthcare Provider Details

I. General information

NPI: 1942138490
Provider Name (Legal Business Name): MADELINE BAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 MAIN ST
WRAY CO
80758-1707
US

IV. Provider business mailing address

29920 COUNTY ROAD 35
WRAY CO
80758-9363
US

V. Phone/Fax

Practice location:
  • Phone: 970-332-4817
  • Fax:
Mailing address:
  • Phone: 605-228-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00206609
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: