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General NPI Number Information
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NPI Number | 1518520964
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Entity Type | Organization
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Legal Business Name | RB DMD PLLC
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Dates
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Enumeration Date | 04/20/2019
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Last Update Date | 04/20/2019
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Provider Practice Location Address
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Address Line | 3435 E PONY EXPRESS PARKWAY SUITE 110
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-1204
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Country | US
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Telephone | 801-310-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 8511 S 1330 E STE 110
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City | SANDY
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State | UT
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Zip | 84093-1321
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Country | US
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Telephone | 801-310-6777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ALLEN BALDWIN
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Credential | DMD
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Telephone | 801-310-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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