Provider Demographics
NPI:1326156803
Name:BAUGHN, BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:BAUGHN
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 1:7515 CAMERON ROAD SUITE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-371-1252
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:3106 SOUTH WS YOUNG
Practice Address - Street 2:STE C304
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-618-5050
Practice Address - Fax:254-618-5681
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist