Provider Demographics
NPI:1528076510
Name:MIER-BAUTISTA, MARIA LUISA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:MIER-BAUTISTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 LAGUNA BLVD.
Mailing Address - Street 2:STE 2
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-684-1922
Mailing Address - Fax:916-684-1938
Practice Address - Street 1:8101 LAGUNA BLVD.
Practice Address - Street 2:STE 2
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-684-1922
Practice Address - Fax:916-684-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist