Active NPI
Agnes Bautista Banias, RDH
- Dental Hygienist
- Norfolk, VA
National Provider Identifier
1205188307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 8471
- Practice address
- 1647 Admiral Taussig Blvd BR Health Clinic
Naval Medical Center Portsmouth
Norfolk, VA 23511 - Phone
- (757) 953-7011
- NPI assigned
- Oct 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 8471 | NC | Primary |
Addresses
Primary practice location
1647 Admiral Taussig Blvd BR Health Clinic
Naval Medical Center Portsmouth
Norfolk, VA 23511
Mailing address
1647 Admiral Taussig Blvd BR Health Clinic
Naval Medical Center Portsmouth
Norfolk, VA 23511
Phone (757) 953-7011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8471 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350000000000",
"number": "1205188307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1647 ADMIRAL TAUSSIG BLVD BR HEALTH CLINIC",
"address_2": "NAVAL MEDICAL CENTER PORTSMOUTH",
"city": "NORFOLK",
"state": "VA",
"postal_code": "23511",
"telephone_number": "757-953-7011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1647 ADMIRAL TAUSSIG BLVD BR HEALTH CLINIC",
"address_2": "NAVAL MEDICAL CENTER PORTSMOUTH",
"city": "NORFOLK",
"state": "VA",
"postal_code": "23511",
"telephone_number": "757-953-7011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANIAS",
"first_name": "AGNES",
"middle_name": "BAUTISTA",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-12",
"last_updated": "2012-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "NC",
"license": "8471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.