MEDICARE: DR. CHARLES DALE BAUER DDS

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	4565	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05473	OTHER	NE	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194739276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DALE BAUER DDS

Provider Business Mailing Address
First Line	:	2115 N KANSAS AVE
Second Line	:	SUITE #202
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-462-6410
Fax Number	:	402-462-4463

Provider Business Practice Location Address
First Line	:	2115 N KANSAS AVE
Second Line	:	SUITE #202
City	:	HASTINGS
State	:	NE
Zip	:	68901-2615
Country	:	US
Telephone Number	:	402-462-6410
Fax Number	:	402-462-4463

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/18/2011

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Directions to “ DR. CHARLES DALE BAUER DDS” Practice Location

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