Individual
DR. MARY ANNE BAECHLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
521 N 11TH ST, RICHMOND, VA 23298-5045
(804) 628-0213
(804) 828-2185
Mailing address
2518 OLD HEARTH CT, RICHMOND, VA 23233-1510
(804) 360-8756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
71-000163
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0411000046
DENTAL FULL TIME FACULTY LICENSE
VA
01
—
19478
STATE DENTAL LICENSE
TX
01
—
30-022482
STATE DENTAL LICENSE
OH
01
—
71-000163
LIMITED TEACHING LICENSE
OH
Enumeration date
01/10/2007
Last updated
07/28/2008
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