Healthcare Provider Details

I. General information

NPI: 1407863319
Provider Name (Legal Business Name): MARK A. BAIRD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 KUHIO HWY
KAPAA HI
96746
US

IV. Provider business mailing address

976 KUHIO HWY
KAPAA HI
96746
US

V. Phone/Fax

Practice location:
  • Phone: 808-822-9393
  • Fax: 808-822-7993
Mailing address:
  • Phone: 808-822-9393
  • Fax: 808-822-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1091
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: