Individual provider Active NPI

Baljot Bains, DDS

  • Pediatric Dentistry
  • Modesto, CA
National Provider Identifier
1316254121
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
63365 Issued in CA
Practice address
4120 Prescott Rd Ste B
Modesto, CA 95356-8418
Phone
(209) 718-4300
NPI assigned
Sep 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 25935 TX
Pediatric Dentistry 1223P0221X 63365 CA Primary

Addresses

Primary practice location

4120 Prescott Rd Ste B
Modesto, CA 95356-8418

Mailing address

3304 Ridgemont CT
Modesto, CA 95355-8449
Phone (650) 296-8417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150803001999 TX Order and Referring Only - DentistPractitioner - Dentist 4587978663

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63365CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Bains Dental Corporation CurrentSince Feb 27, 2022 Accepting new patients

Locations

4120 Prescott Rd
#B
Modesto, CA 95356
Phone (209) 544-7300

Interoperability endpoints

  • Direct secure messaging: bbains382728@hisp.ehr.sutterhealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1316254121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 RIDGEMONT CT",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953558449",
            "telephone_number": "650-296-8417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 PRESCOTT RD STE B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568418",
            "telephone_number": "209-718-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAINS",
        "first_name": "BALJOT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-01",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "25935",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "63365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.