Healthcare Provider Details

I. General information

NPI: 1982748802
Provider Name (Legal Business Name): BAUMSTARK AND HYDE ORAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 COLONY DR N SUITE 1
SAGINAW MI
48638-7187
US

IV. Provider business mailing address

5605 COLONY DR N SUITE 1
SAGINAW MI
48638-7187
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-0320
  • Fax:
Mailing address:
  • Phone: 989-793-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMI

VIII. Authorized Official

Name: REYNOLD JOSEPH BAUMSTARK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 989-793-0320