Healthcare Provider Details

I. General information

NPI: 1629496161
Provider Name (Legal Business Name): DOUGLAS BAASCH MD,DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19503 7TH AVE NE STE 100
POULSBO WA
98370-7529
US

IV. Provider business mailing address

19503 7TH AVE NE STE 100
POULSBO WA
98370-7529
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-2339
  • Fax:
Mailing address:
  • Phone: 360-779-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61032347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: