Provider Demographics
NPI:1235402041
Name:BAGGA, BALBIR R (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BALBIR
Middle Name:R
Last Name:BAGGA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3841
Mailing Address - Country:US
Mailing Address - Phone:414-744-3333
Mailing Address - Fax:414-744-1155
Practice Address - Street 1:3814 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3841
Practice Address - Country:US
Practice Address - Phone:414-744-3333
Practice Address - Fax:414-744-1155
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25451223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447390521OtherGROUP PIN