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General NPI Number Information
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NPI Number | 1154311744
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Entity Type | Individual
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Provider Name | DOUGLAS L. BAUMGARDNER DMD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 104 N WALTERS AVE
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City | HODGENVILLE
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State | KY
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Zip | 42748-1532
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Country | US
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Telephone | 270-358-3189
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Fax | 270-358-3180
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Provider Business Mailing Address
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Address Line | 2386 SPORTSMAN LAKE RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8222
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Country | US
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Telephone | 270-735-1787
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5955
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License Number State | KY
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