Provider Demographics
NPI:1316254121
Name:BAINS, BALJOT (DDS)
Entity type:Individual
Prefix:
First Name:BALJOT
Middle Name:
Last Name:BAINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 RIDGEMONT CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8449
Mailing Address - Country:US
Mailing Address - Phone:650-296-8417
Mailing Address - Fax:
Practice Address - Street 1:4120 PRESCOTT RD STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8418
Practice Address - Country:US
Practice Address - Phone:209-718-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259351223P0221X
CA633651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry