Healthcare Provider Details

I. General information

NPI: 1376762435
Provider Name (Legal Business Name): ALAN C BAUGH DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 W 12600 S STE 210
RIVERTON UT
84065
US

IV. Provider business mailing address

4019 W 12600 S STE 210
RIVERTON UT
84065
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-6460
  • Fax:
Mailing address:
  • Phone: 801-253-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number374379-9921
License Number StateUT

VIII. Authorized Official

Name: DR. ALAN C. BAUGH
Title or Position: ORTHODONTIST
Credential: D.M.D., P.C.
Phone: 801-253-6460