Jerry George Baumgartner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3631 Issued in WI

Practice address

2724 Brave Rifles Regiment Rd
HQ USA Dental Activity
Fort Knox, KY 40121-5111

Phone

(502) 624-6158

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437257599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S3740A WOODLAND RD",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "54665",
            "telephone_number": "608-634-6933",
            "fax_number": "608-637-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2724 BRAVE RIFLES REGIMENT RD",
            "address_2": "HQ USA DENTAL ACTIVITY",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401215111",
            "telephone_number": "502-624-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUMGARTNER",
        "first_name": "JERRY",
        "middle_name": "GEORGE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33486700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Ruth Baker, PA-C
• Eric Raymond Bales, ATC
• Geoffrey S. Ball, D.M.D.
• Kathryn Maria Barger, LCSW, CADC
• Daniel Joseph Bartz, PA-C
• Angela Beanblossom, LCSW
• Kayla Beekman
• Steven Wayne Binkley, DMD
• Richard Edward Borders, D.M.D.
• Laura Elizabeth Bottoms, RDN, LD

• All providers in Fort Knox, KY
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.