Provider Demographics
NPI:1548679400
Name:BAUER, JILL (RDH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BAUER
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 1:2740 IRONSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407
Mailing Address - Country:US
Mailing Address - Phone:707-703-3703
Mailing Address - Fax:707-666-7091
Practice Address - Street 1:2740 IRONSTONE CIRCLE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407
Practice Address - Country:US
Practice Address - Phone:707-703-3703
Practice Address - Fax:707-666-7091
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist