Provider Demographics
NPI:1649869587
Name:BAINS DENTAL CORPORATION
Entity type:Organization
Organization Name:BAINS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BALJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-718-4300
Mailing Address - Street 1:3304 RIDGEMONT CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4120 PRESCOTT RD STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8418
Practice Address - Country:US
Practice Address - Phone:650-296-8417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental