MEDICARE: JOHN C. BAIN, DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2408	AR

General Provider Information

NPI Number	:	1093734188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C. BAIN, DDS, PA

Provider Business Mailing Address
First Line	:	PO BOX 1570
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-1570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 SOUTHWINDS RD
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8660
Country	:	US
Telephone Number	:	479-267-4900
Fax Number	:

Authorized Official
Title or Position	:	OWNER, DENTIST
Name	:	DR. JOHN C BAIN
Credential	:	DDS
Telephone Number	:	479-267-4900

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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