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General NPI Number Information
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NPI Number | 1013067115
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Entity Type | Individual
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Provider Name | JONATHAN W BAUTER DDS
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 210 W MALLARD DR STE E
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City | BOISE
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State | ID
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Zip | 83706-3992
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Country | US
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Telephone | 208-344-8363
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Fax |
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Provider Business Mailing Address
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Address Line | 210 W MALLARD DR STE E
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City | BOISE
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State | ID
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Zip | 83706-3992
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Country | US
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Telephone | 208-344-8363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4714
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-4357
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License Number State | ID
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