Provider Demographics
NPI:1568589695
Name:BAGGETT, JOHN ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:BAGGETT
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 1:100 HAMPTON DR STE A
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-7902
Mailing Address - Country:US
Mailing Address - Phone:205-668-1599
Mailing Address - Fax:
Practice Address - Street 1:100 HAMPTON DR STE A
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-7902
Practice Address - Country:US
Practice Address - Phone:205-668-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51538433OtherBCBS OF AL