Provider Demographics
NPI:1376797514
Name:BAGGETT, THOMAS BENJAMIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BENJAMIN
Last Name:BAGGETT
Suffix:III
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 1:89 NOTCH SHOPPING CENTER LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737
Mailing Address - Country:US
Mailing Address - Phone:417-338-4772
Mailing Address - Fax:417-338-4774
Practice Address - Street 1:89 NOTCH SHOPPING CENTER LANE
Practice Address - Street 2:SUITE C
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737
Practice Address - Country:US
Practice Address - Phone:417-338-4772
Practice Address - Fax:417-338-4774
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070192101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice