Individual
AGNES BAUTISTA BANIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1647 ADMIRAL TAUSSIG BLVD BR HEALTH CLINIC, NAVAL MEDICAL CENTER PORTSMOUTH, NORFOLK, VA 23511
(757) 953-7011
Mailing address
1647 ADMIRAL TAUSSIG BLVD BR HEALTH CLINIC, NAVAL MEDICAL CENTER PORTSMOUTH, NORFOLK, VA 23511
(757) 953-7011
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
8471
NC
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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