Organization
BAINES DENTAL, LLC
Active
Other names
Baines Dental Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAY L CRAWFORD (OFFICE MANAGER)
(217) 698-9300
Entity
Organization
Contact information
Practice address
1112 RICKARD RD STE A, SPRINGFIELD, IL 62704-1021
(217) 698-9300
(217) 698-9310
Mailing address
1112 RICKARD RD STE A, SPRINGFIELD, IL 62704-1021
(217) 698-9300
(217) 698-9310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679766638
NPI
IL
Enumeration date
01/14/2019
Last updated
01/14/2019
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