Provider Demographics
NPI:1629685185
Name:BAYNES, RHETT AUSTIN
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:AUSTIN
Last Name:BAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 SELWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-9671
Mailing Address - Country:US
Mailing Address - Phone:760-828-8250
Mailing Address - Fax:
Practice Address - Street 1:2360 THAIN GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4115
Practice Address - Country:US
Practice Address - Phone:208-717-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-52091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice