Provider Demographics
NPI:1194126730
Name:BAUER, TERRYL
Entity type:Individual
Prefix:MRS
First Name:TERRYL
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W47 COUNTY ROAD Z
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-9577
Mailing Address - Country:US
Mailing Address - Phone:715-946-3226
Mailing Address - Fax:
Practice Address - Street 1:W47 COUNTY ROAD Z
Practice Address - Street 2:
Practice Address - City:ELEVA
Practice Address - State:WI
Practice Address - Zip Code:54738-9577
Practice Address - Country:US
Practice Address - Phone:715-946-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6665-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist