Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS1812 | TN |
NPI | 1487645198 |
---|---|
Provider Name | Dr. Gordon Joseph Baird JR. |
First Address | Crossville, TN 38558-2639 |
Second Address | Loudon, TN 37774-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |