Healthcare Provider Details

I. General information

NPI: 1538631981
Provider Name (Legal Business Name): BASELINE DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 E BASELINE ROAD SUITE 101
TEMPE AZ
85283
US

IV. Provider business mailing address

1980 E BASELINE ROAD SUITE 101
TEMPE AZ
85283
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-3515
  • Fax: 480-491-2871
Mailing address:
  • Phone: 480-820-3515
  • Fax: 480-491-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOEL ANDREW SHUMWAY
Title or Position: PARTNER
Credential: DDS
Phone: 480-820-3515