Provider Demographics
NPI:1427128040
Name:BAIM, LOREN C (DDS)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:C
Last Name:BAIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2839
Mailing Address - Country:US
Mailing Address - Phone:518-793-6619
Mailing Address - Fax:518-798-3415
Practice Address - Street 1:28 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2839
Practice Address - Country:US
Practice Address - Phone:518-793-6619
Practice Address - Fax:518-798-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039548-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164592Medicaid