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Provider Information for 1356506596



MR. KENNETH JAMES BAUER D.D.S

Gender: MALE

Individual NPI: 1356506596

Calendar Last Updated: 2008-07-28

Details

Name Value
NPI 1356506596
Enumeration Date 2008-07-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 55 MISSION CIR STE 107
SANTA ROSA, CA 95409-5372
United States

Phone: 707-538-1086 | Fax: 707-538-0934
View Map External Link
Primary Practice Address 55 MISSION CIR STE 107
SANTA ROSA, CA 95409-5372
United States

Phone: 707-538-1086 | Fax: 707-538-0934
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 34668