Healthcare Provider Details

I. General information

NPI: 1649869587
Provider Name (Legal Business Name): BAINS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 PRESCOTT RD STE B
MODESTO CA
95356-8418
US

IV. Provider business mailing address

3304 RIDGEMONT CT
MODESTO CA
95355-8449
US

V. Phone/Fax

Practice location:
  • Phone: 650-296-8417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BALJOT BAINS
Title or Position: CEO
Credential: DDS
Phone: 209-718-4300