Individual
JERRY GEORGE BAUMGARTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2724 BRAVE RIFLES REGIMENT RD, HQ USA DENTAL ACTIVITY, FORT KNOX, KY 40121-5111
(502) 624-6158
Mailing address
S3740A WOODLAND RD, VIROQUA, WI 54665
(608) 634-6933
(608) 637-2298
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3631
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33486700
—
WI
Enumeration date
09/20/2006
Last updated
07/08/2007
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