Provider Demographics
NPI:1316175011
Name:BAUER, MALINA LYNN (RDH)
Entity type:Individual
Prefix:MRS
First Name:MALINA
Middle Name:LYNN
Last Name:BAUER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MALINA
Other - Middle Name:LYNN
Other - Last Name:BLADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1116 MAIDA VALE LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-5133
Mailing Address - Country:US
Mailing Address - Phone:817-439-2827
Mailing Address - Fax:
Practice Address - Street 1:12420 TIMBERLAND BLVD STE 416
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1230
Practice Address - Country:US
Practice Address - Phone:817-518-1100
Practice Address - Fax:817-518-1106
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15414124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15414OtherRDH LICENSE NUMBER