Provider Demographics
NPI:1013255348
Name:BAUER, ANGIE MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
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 1:16 OREAR LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-3941
Mailing Address - Country:US
Mailing Address - Phone:503-385-3818
Mailing Address - Fax:
Practice Address - Street 1:324 MONGER ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1240
Practice Address - Country:US
Practice Address - Phone:256-835-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7444124Q00000X
ORH6084124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist