Provider Demographics
NPI:1952163123
Name:BASELINE DENTAL LLC
Entity Type:Organization
Organization Name:BASELINE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIKH HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-709-0090
Mailing Address - Street 1:16704 SW COLORADO LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-5280
Mailing Address - Country:US
Mailing Address - Phone:503-709-0090
Mailing Address - Fax:
Practice Address - Street 1:527 SE BASELINE ST STE C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-709-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental