Provider Demographics
NPI:1619023066
Name:BAUGH, BRENT DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DOUGLAS
Last Name:BAUGH
Suffix:
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 1:3540 S 4000 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3260
Mailing Address - Country:US
Mailing Address - Phone:801-969-6200
Mailing Address - Fax:801-963-0359
Practice Address - Street 1:3540 S 4000 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3260
Practice Address - Country:US
Practice Address - Phone:801-969-6200
Practice Address - Fax:801-963-0359
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294522-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist