Provider Demographics
NPI:1336642628
Name:BAUER-LOCKHART, JAMIE (RDH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BAUER-LOCKHART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19242 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-9335
Mailing Address - Country:US
Mailing Address - Phone:906-884-4479
Mailing Address - Fax:
Practice Address - Street 1:401 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1444
Practice Address - Country:US
Practice Address - Phone:906-884-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014441124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist