Provider Demographics
NPI:1417661091
Name:BAHA DENTISTRY INC.
Entity Type:Organization
Organization Name:BAHA DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-610-7200
Mailing Address - Street 1:1315 N HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2484
Mailing Address - Country:US
Mailing Address - Phone:602-478-9740
Mailing Address - Fax:
Practice Address - Street 1:2183 W MAIN ST STE A301
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6763
Practice Address - Country:US
Practice Address - Phone:801-610-7200
Practice Address - Fax:801-770-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental