Healthcare Provider Details

I. General information

NPI: 1134987324
Provider Name (Legal Business Name): BEATRICE ANNE BAUTISTA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PHILOSOPHERS TER
CHESTERTOWN MD
21620-1715
US

IV. Provider business mailing address

301 RANDOLPH ST
DENTON MD
21629-1243
US

V. Phone/Fax

Practice location:
  • Phone: 443-215-5353
  • Fax: 833-972-5853
Mailing address:
  • Phone: 410-479-4306
  • Fax: 833-972-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3158
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: