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Baseline Dental, PC

Dentist, General Practice in Phoenix, AZ. Organization (NPI-2).

NPI number1083005136
StatusActive
Last updated in NPPESDec 6, 2016

Details

NPI
1083005136
Entity type
Organization (NPI-2)
Legal business name
Baseline Dental, PC
Organization subpart
No
Enumeration date
Feb 11, 2015
Last updated
Dec 6, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes
1223E0200X Dentist, Endodontics––
1223S0112X Dentist, Oral and Maxillofacial Surgery––

Practice location

2030 W Baseline Rd Ste 176
Phoenix, AZ 85041-6574

Phone 770-916-5031 · Fax 678-247-7966

Mailing address

1090 Northchase Pkwy Se Ste 150
Marietta, GA 30067-6407

Phone 770-916-5031 · Fax 678-247-7966

Authorized official

Dale M. Mayfield
President
7709165031

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