Provider Demographics
NPI:1457835647
Name:BAUM, LORELLE LAYDEN (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LORELLE
Middle Name:LAYDEN
Last Name:BAUM
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 NORTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8526
Mailing Address - Country:US
Mailing Address - Phone:252-457-5668
Mailing Address - Fax:757-953-6439
Practice Address - Street 1:1288 NORTHSIDE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8526
Practice Address - Country:US
Practice Address - Phone:252-457-5668
Practice Address - Fax:757-953-6439
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant