Provider Demographics
NPI:1982979456
Name:BAXTER, JOANN CRYSTAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:CRYSTAL
Last Name:BAXTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16127 E POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6505
Mailing Address - Country:US
Mailing Address - Phone:480-836-8318
Mailing Address - Fax:480-451-9737
Practice Address - Street 1:16127 E POWDERHORN DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6505
Practice Address - Country:US
Practice Address - Phone:480-836-8318
Practice Address - Fax:480-451-9737
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics