Healthcare Provider Details

I. General information

NPI: 1902175334
Provider Name (Legal Business Name): DEAN BAUGH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 S MARINE CORPS DR
TAMUNING GU
96913-3539
US

IV. Provider business mailing address

PO BOX 6578
TAMUNING GU
96931-6578
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-5824
  • Fax: 671-647-3556
Mailing address:
  • Phone: 671-646-6956
  • Fax: 671-647-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD1007
License Number StateGU

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: