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General NPI Number Information
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NPI Number | 1992798177
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Entity Type | Organization
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Legal Business Name | AM BAUER DDS & JT BECK DDS & ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 848 SCIOTO ST
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City | URBANA
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State | OH
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Zip | 43078-2255
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Country | US
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Telephone | 937-653-7623
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Fax | 937-653-6916
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Provider Business Mailing Address
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Address Line | 848 SCIOTO ST
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City | URBANA
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State | OH
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Zip | 43078-2255
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Country | US
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Telephone | 937-653-7623
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Fax | 937-653-6916
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNETTE M. BAUER
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Credential | D.D.S.
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Telephone | 937-653-7623
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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 | 14048
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License Number State | OH
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