Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8746 | TX |
NPI | 1043212202 |
---|---|
Provider Name | Dr. Lou R. Baeten |
First Address | San Antonio, TX 78233-3264 |
Second Address | San Antonio, TX 78233-3264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |