Provider Demographics
NPI:1205370152
Name:BAUCHE DENTAL PC
Entity Type:Organization
Organization Name:BAUCHE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BAUCHE
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-260-8481
Mailing Address - Street 1:5135 N CAMINO ESPLENDORA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6226
Mailing Address - Country:US
Mailing Address - Phone:520-260-8481
Mailing Address - Fax:
Practice Address - Street 1:5639 E 5TH ST STE G
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2443
Practice Address - Country:US
Practice Address - Phone:520-571-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty