Provider Demographics
NPI:1194294488
Name:BAUGH, KENT JOSEPH (DMD PC)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:JOSEPH
Last Name:BAUGH
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 E 5900 S STE A109
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7248
Mailing Address - Country:US
Mailing Address - Phone:801-266-0061
Mailing Address - Fax:801-266-2206
Practice Address - Street 1:164 E 5900 S STE A109
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7248
Practice Address - Country:US
Practice Address - Phone:801-266-0061
Practice Address - Fax:801-266-2206
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1409811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT140981OtherSTATE OF UTAH LICENSE