Kenneth Roger Baumgartner, DDS
Individual provider Active NPI General Practice Dentistry · Fort Bragg, CA
NPI 1205933926 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205933926
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 34056 (CA)
- Practice address
- 18175 N Highway One
Fort Bragg, CA 95437 - Phone
- (707) 964-0440
- Fax
- (707) 964-8373
- NPI assigned
- Sep 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Interoperability endpoints
- ken.baumgartner.p1@direct.mccinc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34056 | CA | Yes |
Addresses
Primary practice location
18175 N Highway One
Fort Bragg, CA 95437
Mailing address
18175 N Highway One
Fort Bragg, CA 95437
Phone (707) 964-0440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B34056 | Medicaid | CA | |
| DS034056 | Other | BCBS | |
| 825575 | Other | UNITED CONCORDIA |
Other names
- Ken Baumgartner
Other providers in Fort Bragg, CA
- Gregory Baer
- M. Lee Baker
- Genevieve Marilyn Banegas
- Nadine R. Barlow
- Willow Bartholomew
- Carrie Becker Fishman
- Joseph Edward Beeney
- Jack Linn Bellah
- Logan Christopher Bengston
- Zoe D Berna
All providers in Fort Bragg, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.