Healthcare Provider Details

I. General information

NPI: 1992818066
Provider Name (Legal Business Name): C BRUCE BAIRD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 UNIVERSITY AVENUE
SEWANEE TN
37375
US

IV. Provider business mailing address

PO BOX 817
SEWANEE TN
37375
US

V. Phone/Fax

Practice location:
  • Phone: 931-598-0088
  • Fax: 931-598-9763
Mailing address:
  • Phone: 931-598-0088
  • Fax: 931-598-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3859
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: