Healthcare Provider Details

I. General information

NPI: 1639274145
Provider Name (Legal Business Name): RICHARD THOMAS BAUMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 S FASHION BLVD #275
MURRAY UT
84107-7381
US

IV. Provider business mailing address

6065 S FASHION BLVD #275
MURRAY UT
84107-7381
US

V. Phone/Fax

Practice location:
  • Phone: 801-590-8687
  • Fax: 801-590-8617
Mailing address:
  • Phone: 801-590-8687
  • Fax: 801-590-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5930166
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: