Organization
MRB ENTERPRISES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP ROBERT BAYNE D.D.S. (OWNER/PRESIDENT)
(563) 381-4830
Entity
Organization
Contact information
Practice address
133 E MAYNE ST, BLUE GRASS, IA 52726-9718
(563) 381-4830
Mailing address
133 E MAYNE ST, BLUE GRASS, IA 52726-9718
(563) 381-4830
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7609
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11501
BLUE CROSS BLUE SHIELD
IA
01
—
1154355162
TYPE I NPI
IA
Enumeration date
05/14/2009
Last updated
05/14/2009
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