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General NPI Number Information
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NPI Number | 1134573207
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Entity Type | Organization
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Legal Business Name | YOUR ENDODONTIC SPECIALIST, PA
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 24820 BURNT PINE DR SUITE 3
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-2028
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Country | US
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Telephone | 239-676-1079
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Fax |
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Provider Business Mailing Address
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Address Line | 24820 BURNT PINE DR SUITE 3
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-2028
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Country | US
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Telephone | 239-676-1079
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT T BAUR
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Credential | PHD, DMD
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Telephone | 813-313-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN 17788
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License Number State | FL
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