Healthcare Provider Details

I. General information

NPI: 1124099692
Provider Name (Legal Business Name): AMMON J BAUS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 EUGENE ST
CATASAUQUA PA
18032
US

IV. Provider business mailing address

223 EUGENE ST
CATASAUQUA PA
18032
US

V. Phone/Fax

Practice location:
  • Phone: 610-266-0466
  • Fax: 610-266-8665
Mailing address:
  • Phone: 610-266-0466
  • Fax: 610-266-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS031443L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: