Provider Demographics
NPI:1699880260
Name:BAUMAN, GEOFFREY RODMAN (DMD MS)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:RODMAN
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N 21ST ST
Mailing Address - Street 2:#102A
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-366-7207
Mailing Address - Fax:740-366-7207
Practice Address - Street 1:843 N 21ST ST
Practice Address - Street 2:#102A
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-366-7207
Practice Address - Fax:740-366-7207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300203891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBA0824031Medicare ID - Type Unspecified
466336Medicare UPIN