Healthcare Provider Details

I. General information

NPI: 1114016441
Provider Name (Legal Business Name): JOSEPH G BABA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 E DOUGLAS AVE STE 102
WICHITA KS
67208-3900
US

IV. Provider business mailing address

4620 E DOUGLAS AVE STE 102
WICHITA KS
67208-3900
US

V. Phone/Fax

Practice location:
  • Phone: 316-263-2444
  • Fax: 316-260-2401
Mailing address:
  • Phone: 316-263-2444
  • Fax: 316-260-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5883
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5883
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: