Healthcare Provider Details

I. General information

NPI: 1639111800
Provider Name (Legal Business Name): MICHAEL ORRIN BAIRD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HIGHWAY 69 SUITE #5
DEWEY AZ
86327-9502
US

IV. Provider business mailing address

150 S HIGHWAY 69 SUITE #5
DEWEY AZ
86327-9502
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-8333
  • Fax: 928-632-5537
Mailing address:
  • Phone: 928-632-8333
  • Fax: 928-632-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6645
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: