Healthcare Provider Details

I. General information

NPI: 1639736382
Provider Name (Legal Business Name): KYLE BAIRD DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 E 29TH AVE STE 104
SPOKANE WA
99203-3961
US

IV. Provider business mailing address

2204 E 29TH AVE STE 104
SPOKANE WA
99203-3961
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-1404
  • Fax:
Mailing address:
  • Phone: 550-932-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61533860
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD61570725
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: