Healthcare Provider Details

I. General information

NPI: 1710095260
Provider Name (Legal Business Name): ALICIA ANNE RISNER-BAUMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA ANNE RISNER DDS

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

IV. Provider business mailing address

34 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

V. Phone/Fax

Practice location:
  • Phone: 570-827-0145
  • Fax:
Mailing address:
  • Phone: 570-827-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038027
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number044761-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: