MEDICARE: DR. EDWARD MCARTHUR BAUST III DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10724	NC

General Provider Information

NPI Number	:	1033649249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MCARTHUR BAUST III DMD

Provider Business Mailing Address
First Line	:	2905 BRIARCLIFFE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3076
Country	:	US
Telephone Number	:	252-756-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 BRIARCLIFFE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3076
Country	:	US
Telephone Number	:	404-729-9508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	04/01/2022

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