Healthcare Provider Details

I. General information

NPI: 1407336084
Provider Name (Legal Business Name): ARIE BAUER DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAIN ST
WILLISTON ND
58801-5327
US

IV. Provider business mailing address

501 MAIN ST
WILLISTON ND
58801-5327
US

V. Phone/Fax

Practice location:
  • Phone: 701-577-2261
  • Fax:
Mailing address:
  • Phone: 701-577-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2342
License Number StateND

VIII. Authorized Official

Name: ARIE W BAUER
Title or Position: DENTIST
Credential: DDS
Phone: 701-578-4901