MEDICARE: ROBERT RILEY BAUER

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	1223P0221X	Pediatric Dentistry	2025012188	MO

General Provider Information

NPI Number	:	1841975893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RILEY BAUER

Provider Business Mailing Address
First Line	:	251 S SILVER SPRINGS RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6309
Country	:	US
Telephone Number	:	573-579-5985
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 S SILVER SPRINGS RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6309
Country	:	US
Telephone Number	:	573-334-5545
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	10/08/2025

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