Provider Demographics
NPI:1235220427
Name:HAL C BAWDEN DDS PC
Entity Type:Organization
Organization Name:HAL C BAWDEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-256-0808
Mailing Address - Street 1:10011 SOUTH CENTENNIAL PARKWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070
Mailing Address - Country:US
Mailing Address - Phone:801-256-0808
Mailing Address - Fax:801-566-0455
Practice Address - Street 1:10011 SOUTH CENTENNIAL PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:801-256-0808
Practice Address - Fax:801-566-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3727839922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty