Provider Demographics
NPI:1164103750
Name:BAGGOTT DENTAL, LLC
Entity Type:Organization
Organization Name:BAGGOTT DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BAGGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-490-1232
Mailing Address - Street 1:3365 S. 103RD ST.
Mailing Address - Street 2:STE 220
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:414-543-9911
Mailing Address - Fax:414-543-9911
Practice Address - Street 1:3365 S. 103RD ST.
Practice Address - Street 2:STE 220
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-543-9911
Practice Address - Fax:414-543-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty