Provider Demographics
NPI:1376762435
Name:ALAN C BAUGH DMD, PC
Entity Type:Organization
Organization Name:ALAN C BAUGH DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:801-253-6460
Mailing Address - Street 1:4019 W 12600 S
Mailing Address - Street 2:STE 210
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065
Mailing Address - Country:US
Mailing Address - Phone:801-253-6460
Mailing Address - Fax:
Practice Address - Street 1:4019 W 12600 S
Practice Address - Street 2:STE 210
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-253-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374379-9921261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental