Individual
KELLY BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
102 FLAG LAKE DR STE C, LAKE JACKSON, TX 77566-6215
(979) 297-1201
(979) 297-6226
Mailing address
110 FLAG DR E, LAKE JACKSON, TX 77566-6006
(979) 297-1634
(979) 297-6226
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5289
TX
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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