Provider Demographics
NPI:1538301114
Name:CASCADE FAMILY DENTAL
Entity Type:Organization
Organization Name:CASCADE FAMILY DENTAL
Other - Org Name:ASPEN FAMILY DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-465-4490
Mailing Address - Street 1:1392 TURF FARM WAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-6500
Mailing Address - Country:US
Mailing Address - Phone:801-465-4490
Mailing Address - Fax:801-465-4259
Practice Address - Street 1:1392 TURF FARM WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-6500
Practice Address - Country:US
Practice Address - Phone:801-465-4490
Practice Address - Fax:801-465-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT64662621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty