Provider Demographics
NPI:1518520964
Name:RB DMD PLLC
Entity Type:Organization
Organization Name:RB DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-310-6777
Mailing Address - Street 1:8511 S 1330 E STE 110
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1321
Mailing Address - Country:US
Mailing Address - Phone:801-310-6777
Mailing Address - Fax:
Practice Address - Street 1:3435 E PONY EXPRESS PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-1204
Practice Address - Country:US
Practice Address - Phone:801-310-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental