Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 7444 | AL |
N | 124Q00000X | Dental Hygienist | H6084 | OR |
NPI | 1013255348 |
---|---|
Provider Name | Angie Marie Bauer |
First Address | Oxford, AL 36203-3941 |
Second Address | Oxford, AL 36203-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2013 |
Last Update Date | 22/01/2013 |