Healthcare Provider Details

I. General information

NPI: 1295953354
Provider Name (Legal Business Name): BAUGH ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E 5900 S STE A-109
MURRAY UT
84107-7256
US

IV. Provider business mailing address

164 E 5900 S STE A-109
MURRAY UT
84107-7256
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-0061
  • Fax:
Mailing address:
  • Phone: 801-266-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number140981-9921
License Number StateUT

VIII. Authorized Official

Name: DR. KENT J. BAUGH
Title or Position: ORTHODONTIST
Credential: D.M.D., P.C.
Phone: 801-266-0061