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General NPI Number Information
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NPI Number | 1013141373
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Entity Type | Organization
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Legal Business Name | MRB ENTERPRISES PC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 133 E MAYNE ST
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City | BLUE GRASS
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State | IA
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Zip | 52726-9718
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Country | US
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Telephone | 563-381-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 133 E MAYNE ST
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City | BLUE GRASS
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State | IA
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Zip | 52726-9718
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Country | US
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Telephone | 563-381-4830
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PHILIP ROBERT BAYNE
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Credential | D.D.S.
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Telephone | 563-381-4830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7609
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License Number State | IA
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