Provider Demographics
NPI:1477112779
Name:BAUGH, ALAN CLAWSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CLAWSON
Last Name:BAUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 W 12600 S STE 210
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7407
Mailing Address - Country:US
Mailing Address - Phone:801-253-6460
Mailing Address - Fax:
Practice Address - Street 1:4019 W 12600 S STE 210
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7407
Practice Address - Country:US
Practice Address - Phone:801-253-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT37437999211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics