Provider Demographics
NPI:1720180573
Name:BAIRD, ROBERT THOMAS (DDS PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:BAIRD
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-0488
Mailing Address - Country:US
Mailing Address - Phone:912-576-5506
Mailing Address - Fax:912-576-5888
Practice Address - Street 1:308 BEDELL AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-0488
Practice Address - Country:US
Practice Address - Phone:912-576-5506
Practice Address - Fax:912-576-5888
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9180224OtherDORAL DENTAL USA LLC
GA000794323OtherTRICARE/UNITED CONCORDIA
GA00244835AMedicaid