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General NPI Number Information
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NPI Number | 1679710107
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Entity Type | Individual
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Provider Name | DR. GORDON P. BAUSMAN
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Gender | Male
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 210 N. FRONT ST.
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City | RENSSELAER
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State | IN
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Zip | 47978
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Country | US
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Telephone | 219-866-4533
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N. FRONT ST.
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City | RENSSELAER
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State | IN
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Zip | 47978
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Country | US
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Telephone | 219-866-4533
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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 | IN7571
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License Number State | IN
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