=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417172099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILA CATHRYN BAGLEY RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3540 SPRINGDALE ROAD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-385-8482
-----------------------------------------------------
Fax | 513-385-5705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 TIMBERMAN ROAD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-863-8568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 002216
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------