Provider Demographics
NPI:1912398603
Name:BAITNER PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BAITNER PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:YAEL
Authorized Official - Last Name:BAITNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:754-263-2433
Mailing Address - Street 1:4480 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3511
Mailing Address - Country:US
Mailing Address - Phone:754-263-2433
Mailing Address - Fax:954-966-6644
Practice Address - Street 1:4480 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3511
Practice Address - Country:US
Practice Address - Phone:754-263-2433
Practice Address - Fax:954-966-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty