Provider Demographics
NPI:1992902423
Name:BAER, DAVID RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:BAER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 PEPPER LANE
Mailing Address - Street 2:STE A
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005
Mailing Address - Country:US
Mailing Address - Phone:719-696-9009
Mailing Address - Fax:719-924-9493
Practice Address - Street 1:2041 PEPPER LANE
Practice Address - Street 2:STE A
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005
Practice Address - Country:US
Practice Address - Phone:719-696-9009
Practice Address - Fax:719-924-9493
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH26431223S0112X
CODEN000096451223S0112X
CO9645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1992902423Medicaid