Gordon P. Bausman
Individual provider Active NPI Dentist · Rensselaer, IN
NPI 1679710107 · NPPES record last updated Jan 21, 2009
Key facts
- NPI
- 1679710107
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- IN7571 (IN)
- Practice address
- 210 N. Front St.
Rensselaer, IN 47978 - Phone
- (219) 866-4533
- NPI assigned
- Jan 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IN7571 | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IN7571 | IN | Yes |
Addresses
Primary practice location
210 N. Front St.
Rensselaer, IN 47978
Mailing address
210 N. Front St.
Rensselaer, IN 47978
Phone (219) 866-4533
Other providers in Rensselaer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2009. 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.