Provider Demographics
NPI:1871668996
Name:MILLCREEK FAMILY DENTAL PC
Entity Type:Organization
Organization Name:MILLCREEK FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-292-4009
Mailing Address - Street 1:1455 S 500 W SUITE D
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8264
Mailing Address - Country:US
Mailing Address - Phone:801-292-4009
Mailing Address - Fax:801-292-3278
Practice Address - Street 1:1455 S 500 W SUITE D
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8264
Practice Address - Country:US
Practice Address - Phone:801-292-4009
Practice Address - Fax:801-292-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty