Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039110 | PA |
Y | 1223X0400X | Orthodontists | DS039110 | PA |
NPI | 1003158528 |
---|---|
Provider Name | Dr. Erin Ruane Bauerle |
First Address | Ardmore, PA 19003-2612 |
Second Address | Havertown, PA 19083-3339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 16/02/2019 |