Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 137384 | UT |
NPI | 1003822032 |
---|---|
Provider Name | Ralph K Bair |
First Address | Logan, UT 84341-7564 |
Second Address | Logan, UT 84341-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |