Healthcare Provider Details

I. General information

NPI: 1912022039
Provider Name (Legal Business Name): MICHAEL O. BAIRD D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S STATE ROUTE 69 SUITE 5F
DEWEY AZ
86327-9502
US

IV. Provider business mailing address

150 S STATE ROUTE 69 SUITE 5F
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: DR. MICHAEL ORRIN BAIRD
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 928-632-8333