Provider Demographics
NPI:1902951288
Name:BAINES, DONNA DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:DENISE
Last Name:BAINES
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 1:3333 W CAMP WISDOM RD
Mailing Address - Street 2:STE. 122
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2557
Mailing Address - Country:US
Mailing Address - Phone:972-709-1979
Mailing Address - Fax:
Practice Address - Street 1:3333 W CAMP WISDOM RD
Practice Address - Street 2:STE. 122
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2557
Practice Address - Country:US
Practice Address - Phone:972-709-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice