Provider Demographics
NPI:1437597416
Name:ALLYSON BAUCH-FRIEDRICH, D.D.S., PLLC
Entity Type:Organization
Organization Name:ALLYSON BAUCH-FRIEDRICH, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAUCH-FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-324-5084
Mailing Address - Street 1:1702 E AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4250
Mailing Address - Country:US
Mailing Address - Phone:361-576-0777
Mailing Address - Fax:361-576-0750
Practice Address - Street 1:1702 E AIRLINE RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4250
Practice Address - Country:US
Practice Address - Phone:361-576-0777
Practice Address - Fax:361-576-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty