Provider Demographics
NPI:1861922346
Name:BAIR, DANIEL ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:BAIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9838 MARDAN DR
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9558
Mailing Address - Country:US
Mailing Address - Phone:517-648-1791
Mailing Address - Fax:
Practice Address - Street 1:214 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9233
Practice Address - Country:US
Practice Address - Phone:517-646-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist