MEDICARE: BAUMAN VENTURES LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1710716147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUMAN VENTURES LLC

Provider Business Mailing Address
First Line	:	4061 KOKANEE LN N
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-4001
Country	:	US
Telephone Number	:	763-614-0454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 MOORE LAKE DR E
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-5153
Country	:	US
Telephone Number	:	763-614-0454
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM M BAUMAN
Credential	:	DDS
Telephone Number	:	763-614-0454

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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