Healthcare Provider Details

I. General information

NPI: 1508507138
Provider Name (Legal Business Name): STEPHEN WILLIAM BAER JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SIMPSON PARK RD
SHELBY NC
28150-4299
US

IV. Provider business mailing address

202 WILLIAMSON RD STE 200
MOORESVILLE NC
28117-7611
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-3366
  • Fax:
Mailing address:
  • Phone: 704-360-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13628
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: