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General NPI Number Information
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NPI Number | 1467466292
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Entity Type | Individual
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Provider Name | TODD KELBY BAUM DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 118 S BRIDGE ST
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City | GRAND LEDGE
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State | MI
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Zip | 48837
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Country | US
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Telephone | 517-627-4027
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Fax | 517-627-6121
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Provider Business Mailing Address
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Address Line | 12169 STATE RD
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City | GRAND LEDGE
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State | MI
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Zip | 48837
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Country | US
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Telephone | 517-622-4099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901015808
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License Number State | MI
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