Healthcare Provider Details

I. General information

NPI: 1356411698
Provider Name (Legal Business Name): BAYLON & BAYLON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11943 CENTRAL AVE NE
BLAINE MN
55434
US

IV. Provider business mailing address

11943 CENTRAL AVE NE
BLAINE MN
55434
US

V. Phone/Fax

Practice location:
  • Phone: 763-757-2914
  • Fax: 763-757-9867
Mailing address:
  • Phone: 763-757-2914
  • Fax: 763-757-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE D BAYLON
Title or Position: DR/OWNER
Credential: D.D.S.
Phone: 763-757-2914