Active NPI
Baleigh Paige Mack, DDS
- General Practice Dentistry
- Longview, TX
National Provider Identifier
1497303283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35241
- Practice address
- 2200 Horseshoe LN
Longview, TX 75605-5648 - Phone
- (903) 753-3673
- NPI assigned
- Aug 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35241 | TX | Primary |
Addresses
Primary practice location
2200 Horseshoe LN
Longview, TX 75605-5648
Mailing address
2200 Horseshoe LN
Longview, TX 75605-5648
Phone (039) 753-3673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35241 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1497303283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 HORSESHOE LN",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055648",
"telephone_number": "039-753-3673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 HORSESHOE LN",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055648",
"telephone_number": "903-753-3673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "BALEIGH",
"middle_name": "PAIGE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-27",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "35241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.