Provider Demographics
NPI:1841790276
Name:CHILDREN'S DENTISTRY OF BAKERSFIELD
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY OF BAKERSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BAIRD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-489-5537
Mailing Address - Street 1:3807 SAN DIMAS ST STE C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1497
Mailing Address - Country:US
Mailing Address - Phone:661-489-5537
Mailing Address - Fax:
Practice Address - Street 1:3807 SAN DIMAS ST STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1497
Practice Address - Country:US
Practice Address - Phone:661-489-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty