Provider Demographics
NPI:1487871604
Name:BATHURST, BETH ELLEN (RDH)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:BATHURST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8515
Mailing Address - Country:US
Mailing Address - Phone:410-222-6861
Mailing Address - Fax:410-222-6688
Practice Address - Street 1:791 AQUAHART RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3961
Practice Address - Country:US
Practice Address - Phone:410-222-6861
Practice Address - Fax:410-222-6688
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist