Provider Demographics
NPI:1003822032
Name:BAIR, RALPH K (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:K
Last Name:BAIR
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 N 400 E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7564
Mailing Address - Country:US
Mailing Address - Phone:435-752-1320
Mailing Address - Fax:435-755-6183
Practice Address - Street 1:1445 N 400 E
Practice Address - Street 2:SUITE 3
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7564
Practice Address - Country:US
Practice Address - Phone:435-752-1320
Practice Address - Fax:435-755-6183
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1373841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics