Provider Demographics
NPI:1114249091
Name:BAIRD, MICHELLE KELLY PHILLIPS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KELLY PHILLIPS
Last Name:BAIRD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:KELLY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:20399 RT 19 SUITE 110
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-776-4088
Mailing Address - Fax:724-776-3955
Practice Address - Street 1:20399 RT 19 SUITE 110
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-776-4088
Practice Address - Fax:724-776-3955
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59136122300000X
PADS039987122300000X
PA050399871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist