Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | IL |
NPI | 1023299724 |
---|---|
Provider Name | Theresa Bauer |
First Address | Chicago Heights, IL 60411-1744 |
Second Address | Chicago Heights, IL 60411-1744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 21/11/2007 |