Charles Dale Bauer, DDS
Individual provider Active NPI General Practice Dentistry · Hastings, NE
NPI 1194739276 · NPPES record last updated Apr 18, 2011
Key facts
- NPI
- 1194739276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4565 (NE)
- Practice address
- 2115 N Kansas Ave
Suite #202
Hastings, NE 68901-2615 - Phone
- (402) 462-6410
- Fax
- (402) 462-4463
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4565 | NE | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hastings Family Dental LLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4565 | NE | Yes |
Addresses
Primary practice location
2115 N Kansas Ave
Suite #202
Hastings, NE 68901-2615
Mailing address
2115 N Kansas Ave
Suite #202
Hastings, NE 68901-2615
Phone (402) 462-6410
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47067078700 | Medicaid | NE | |
| 05473 | Other | NE | BLUE CROSS BLUE SHIELD |
Other providers in Hastings, NE
- Larina Renee Ballheim
- Valentina Barclay
- Charlotte M Barrientez
- Gary W Barth
- Michelle L Batterman
- Kyla Bauer
- Michael Dean Bauer
- Vanetta Bauman
- Sara Elizabeth Baumann
- Wendy Baumeister
All providers in Hastings, NE · General Practice Dentistry in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.