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General NPI Number Information
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NPI Number | 1316175011
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Entity Type | Individual
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Provider Name | MALINA LYNN BAUER RDH
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Gender | Female
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 12420 TIMBERLAND BLVD STE 416
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City | KELLER
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State | TX
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Zip | 76248-1230
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Country | US
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Telephone | 817-518-1100
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Fax | 817-518-1106
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Provider Business Mailing Address
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Address Line | 1116 MAIDA VALE LN
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City | HASLET
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State | TX
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Zip | 76052-5133
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Country | US
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Telephone | 817-439-2827
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 15414
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License Number State | TX
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