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General NPI Number Information
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NPI Number | 1457835647
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Entity Type | Individual
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Provider Name | LORELLE LAYDEN BAUM DENTAL ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 1288 NORTHSIDE RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-8526
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Country | US
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Telephone | 252-457-5668
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Fax | 757-953-6439
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Provider Business Mailing Address
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Address Line | 1288 NORTHSIDE RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-8526
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Country | US
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Telephone | 252-457-5668
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Fax | 757-953-6439
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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