MEDICARE: DR. LAUREN PALMER BAUMGARTNER DMD, DENTAL CORP.

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	62241	CA
2	122300000X	Dentist	62241	CA

General Provider Information

NPI Number	:	1538456173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN PALMER BAUMGARTNER DMD, DENTAL CORP.

Provider Business Mailing Address
First Line	:	160 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2554
Country	:	US
Telephone Number	:	415-456-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2554
Country	:	US
Telephone Number	:	415-456-9242
Fax Number	:

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

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	03/15/2024

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