MEDICARE: JAMES S BAUER DMD INCORPORATED

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	:	1861966954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES S BAUER DMD INCORPORATED

Provider Business Mailing Address
First Line	:	40 MAIN ST N STE E
Second Line	:
City	:	WOODBURY
State	:	CT
Zip	:	06798-2966
Country	:	US
Telephone Number	:	203-263-4402
Fax Number	:	203-263-6211

Provider Business Practice Location Address
First Line	:	40 MAIN ST N STE E
Second Line	:
City	:	WOODBURY
State	:	CT
Zip	:	06798-2966
Country	:	US
Telephone Number	:	203-263-4402
Fax Number	:	203-263-6211

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JAMES SAAR BAUER
Credential	:	DMD
Telephone Number	:	203-263-4402

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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