Provider Demographics
NPI:1720309164
Name:BAI, ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:BAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:XIAOCHUAN
Other - Middle Name:
Other - Last Name:BAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7211 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3611
Mailing Address - Country:US
Mailing Address - Phone:915-841-6725
Mailing Address - Fax:
Practice Address - Street 1:7211 N MESA ST
Practice Address - Street 2:STE. 3E.
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3611
Practice Address - Country:US
Practice Address - Phone:915-841-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214168102Medicaid
TX130880104OtherGROUP MEDICAID
TX742505561OtherGROUP TIN
TX1831267079OtherGROUP NPI
TX00B14GOtherNOVITAS