# BASELINE DENTAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083005136
- **Authorized official:** DALE M. MAYFIELD D.M.D. (PRESIDENT)
- **Authorized official phone:** (770) 916-5031

## Contact information

- **Practice address:** 2030 W BASELINE RD STE 176, PHOENIX, AZ 85041-6574
- **Practice address phone:** (770) 916-5031
- **Practice address fax:** (678) 247-7966
- **Mailing address:** 1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
- **Mailing address phone:** (770) 916-5031
- **Mailing address fax:** (678) 247-7966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 02/11/2015
- **Last updated:** 12/06/2016