Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 14054 | MD |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 8332 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8332 | KY |
NPI | 1043251507 |
---|---|
Provider Name | Dr. Bethany Serafin Awalt |
First Address | Pikesville, MD 21208-1391 |
Second Address | Pikesville, MD 21208-1391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 18/04/2020 |