Provider Demographics
NPI:1013452408
Name:JOSEPH G BABA DDS PA
Entity Type:Organization
Organization Name:JOSEPH G BABA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-263-2444
Mailing Address - Street 1:4620 E DOUGLAS AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3900
Mailing Address - Country:US
Mailing Address - Phone:316-263-2444
Mailing Address - Fax:316-260-2401
Practice Address - Street 1:4620 E DOUGLAS AVE
Practice Address - Street 2:STE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3900
Practice Address - Country:US
Practice Address - Phone:316-263-2444
Practice Address - Fax:316-260-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5883332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment