Provider Demographics
NPI:1689811432
Name:BAUER, MEGAN L (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:L
Last Name:BAUER
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 1:2921 MOHICAN RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2285
Mailing Address - Country:US
Mailing Address - Phone:608-314-9726
Mailing Address - Fax:
Practice Address - Street 1:2921 MOHICAN RD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2285
Practice Address - Country:US
Practice Address - Phone:608-314-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5680-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist