Provider Demographics
NPI:1760595144
Name:BAIRD, ANDREW DALE (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DALE
Last Name:BAIRD
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 S RIVERSHORE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4978
Mailing Address - Country:US
Mailing Address - Phone:208-938-2100
Mailing Address - Fax:
Practice Address - Street 1:483 S RIVERSHORE LN STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4978
Practice Address - Country:US
Practice Address - Phone:208-938-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice