Healthcare Provider Details

I. General information

NPI: 1205922341
Provider Name (Legal Business Name): LAURIE ANNE BAYLIS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

3931 NW 41ST CT
GAINESVILLE FL
32606-4557
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-4040
  • Fax: 352-379-7450
Mailing address:
  • Phone: 325-376-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0007899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: