Provider Demographics
NPI:1104955236
Name:BAIRD ORTHODONTICS, PC
Entity type:Organization
Organization Name:BAIRD ORTHODONTICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-967-3337
Mailing Address - Street 1:5547 S 4015 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4437
Mailing Address - Country:US
Mailing Address - Phone:801-967-3337
Mailing Address - Fax:
Practice Address - Street 1:5547 S 4015 W
Practice Address - Street 2:SUITE 3
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-4437
Practice Address - Country:US
Practice Address - Phone:801-967-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34732899211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty