Provider Demographics
NPI:1659597359
Name:BAIRD, D THAD (DMD)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:THAD
Last Name:BAIRD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4595 TOWNE LAKE PKWY
Mailing Address - Street 2:BLDG 200, STE 110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5514
Mailing Address - Country:US
Mailing Address - Phone:770-517-0444
Mailing Address - Fax:770-517-0493
Practice Address - Street 1:4595 TOWNE LAKE PKWY
Practice Address - Street 2:BLDG 200, STE 110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:770-517-0444
Practice Address - Fax:770-517-0493
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice