Active NPI
David Russell Baer, DDS
- Dentist
- Pueblo, CO
National Provider Identifier
1992902423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9645
- Practice address
- 2041 Pepper Lane
Ste a
Pueblo, CO 81005 - Phone
- (719) 696-9009
- Fax
- (719) 924-9493
- NPI assigned
- Jun 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2643 | OH | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DEN00009645 | CO | |
| Dentist | 122300000X | 9645 | CO | Primary |
Addresses
Primary practice location
2041 Pepper Lane
Ste a
Pueblo, CO 81005
Mailing address
2041 Pepper Lane
Ste a
Pueblo, CO 81005
Phone (719) 696-9009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992902423 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9645 | CO | MD | Dentist |
| DEN00009645 | CO | MD | Oral and Maxillofacial Surgery (Dentist) |
| 2643 | OH | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672704000000",
"number": "1992902423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2041 PEPPER LANE",
"address_2": "STE A",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81005",
"telephone_number": "719-696-9009",
"fax_number": "719-924-9493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2041 PEPPER LANE",
"address_2": "STE A",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81005",
"telephone_number": "719-696-9009",
"fax_number": "719-924-9493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAER",
"first_name": "DAVID",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-28",
"last_updated": "2023-01-03",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "OH",
"license": "2643",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CO",
"license": "DEN00009645",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "9645",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1992902423",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.