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General NPI Number Information
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NPI Number | 1659684652
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Entity Type | Individual
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Provider Name | JEREMY G. BAUER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 2270 NISTLER RD
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City | DELTA JUNCTION
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State | AK
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Zip | 99737-0985
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Country | US
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Telephone | 907-895-4274
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Fax | 907-895-4276
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Provider Business Mailing Address
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Address Line | PO BOX 985
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City | DELTA JUNCTION
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State | AK
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Zip | 99737-0985
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Country | US
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Telephone | 907-895-4274
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Fax | 907-895-4276
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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 | 1436
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License Number State | AK
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