Provider Demographics
NPI:1205028552
Name:BAIRD, JOHN KENTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENTON
Last Name:BAIRD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW AVE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-222-5663
Mailing Address - Fax:559-222-9235
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-222-5663
Practice Address - Fax:559-222-9235
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
18963OtherSTATE LICENSE