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General NPI Number Information
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NPI Number | 1407107063
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Entity Type | Organization
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Legal Business Name | GENE BAINES, D.M.D.
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 509 HIGHWAY 82 W
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City | GREENWOOD
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State | MS
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Zip | 38930-5053
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Country | US
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Telephone | 662-455-3192
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Fax | 662-455-3170
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Provider Business Mailing Address
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Address Line | 509 HIGHWAY 82 W
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City | GREENWOOD
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State | MS
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Zip | 38930-5053
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Country | US
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Telephone | 662-455-3192
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Fax | 662-455-3170
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Authorized Official
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Title or Position | OWNER
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Name | DR. GENE M BAINES
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Credential | D.M.D.
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Telephone | 662-455-3192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | MS1905-80
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License Number State | MS
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