Provider Demographics
NPI:1700151164
Name:BAXTER, RICHARD TURNER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TURNER
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1319
Mailing Address - Country:US
Mailing Address - Phone:205-419-7444
Mailing Address - Fax:205-419-7336
Practice Address - Street 1:2490 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1319
Practice Address - Country:US
Practice Address - Phone:205-419-7444
Practice Address - Fax:205-419-7336
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161641Medicaid