MEDICARE: STANLEY P BAIRD D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5190	AZ

General Provider Information

NPI Number	:	1033328612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY P BAIRD D.D.S

Provider Business Mailing Address
First Line	:	11420 S CIENEGA PARK PL
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-8815
Country	:	US
Telephone Number	:	520-572-4670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 N SILVERBELL RD STE 190
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2292
Country	:	US
Telephone Number	:	520-628-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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