Healthcare Provider Details

I. General information

NPI: 1205022498
Provider Name (Legal Business Name): SEBASTIAN BAUMGAERTEL D.M.D., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 EUCLID AVE
CLEVELAND OH
44106-1712
US

IV. Provider business mailing address

2085 CORNELL RD SUITE 104
CLEVELAND OH
44106-3858
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-3249
  • Fax:
Mailing address:
  • Phone: 216-262-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-022663
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: