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General NPI Number Information
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NPI Number | 1376680298
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Entity Type | Organization
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Legal Business Name | BAXTER DENTAL CENTER
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 W MULBERRY ST
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City | BARABOO
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State | WI
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Zip | 53913
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Country | US
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Telephone | 608-356-3838
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Fax | 608-356-2035
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Provider Business Mailing Address
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Address Line | 501 W MULBERRY ST
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City | BARABOO
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State | WI
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Zip | 53913
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Country | US
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Telephone | 608-356-3838
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Fax | 608-356-2035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY JAMES BAXTER
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Credential | DDS
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Telephone | 608-356-3838
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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 | 3986015
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License Number State | WI
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