Provider Demographics
NPI:1013205509
Name:BAUCH-FRIEDRICH, ALLYSON KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:KAY
Last Name:BAUCH-FRIEDRICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 WOODSPRITE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-2550
Mailing Address - Country:US
Mailing Address - Phone:979-324-5084
Mailing Address - Fax:
Practice Address - Street 1:1505 E RIO GRANDE ST STE 120
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-7397
Practice Address - Country:US
Practice Address - Phone:361-235-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271871223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice