Provider Demographics
NPI:1124099692
Name:BAUS, AMMON J JR (DMD)
Entity type:Individual
Prefix:DR
First Name:AMMON
Middle Name:J
Last Name:BAUS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032
Mailing Address - Country:US
Mailing Address - Phone:610-266-0466
Mailing Address - Fax:610-266-8665
Practice Address - Street 1:223 EUGENE ST
Practice Address - Street 2:
Practice Address - City:CATASAUQUA
Practice Address - State:PA
Practice Address - Zip Code:18032
Practice Address - Country:US
Practice Address - Phone:610-266-0466
Practice Address - Fax:610-266-8665
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031443L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019611170001Medicaid