MEDICARE: DR. TERESA A BAISEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401007152	VA

General Provider Information

NPI Number	:	1174746549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA A BAISEY DDS

Provider Business Mailing Address
First Line	:	9743 S CONGRESS ST
Second Line	:	SUITE B
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9611
Country	:	US
Telephone Number	:	540-740-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	9743 S CONGRESS ST
Second Line	:	SUITE B
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9611
Country	:	US
Telephone Number	:	540-740-3660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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