Provider Demographics
NPI:1194135822
Name:JOLENE BAUER DMD, PC
Entity type:Organization
Organization Name:JOLENE BAUER DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-208-0220
Mailing Address - Street 1:10 S MAIN ST
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1610
Mailing Address - Country:US
Mailing Address - Phone:609-208-0220
Mailing Address - Fax:609-208-0990
Practice Address - Street 1:10 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1610
Practice Address - Country:US
Practice Address - Phone:609-208-0220
Practice Address - Fax:609-208-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020306261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental