Provider Demographics
NPI:1407107063
Name:GENE BAINES, D.M.D.
Entity Type:Organization
Organization Name:GENE BAINES, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-455-3192
Mailing Address - Street 1:509 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-5053
Mailing Address - Country:US
Mailing Address - Phone:662-455-3192
Mailing Address - Fax:662-455-3170
Practice Address - Street 1:509 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5053
Practice Address - Country:US
Practice Address - Phone:662-455-3192
Practice Address - Fax:662-455-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS1905-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty