Provider Demographics
NPI:1770852014
Name:BAIRD, LANDON TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:TAYLOR
Last Name:BAIRD
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 1:1810 SOUTHWEST PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-4700
Mailing Address - Country:US
Mailing Address - Phone:940-723-1511
Mailing Address - Fax:940-723-1514
Practice Address - Street 1:1810 SOUTHWEST PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-4700
Practice Address - Country:US
Practice Address - Phone:940-723-1511
Practice Address - Fax:940-723-1514
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice