MEDICARE: BALDWIN DENTISTRY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN21975	FL
2	122300000X	Dentist	DN21975	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427566223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALDWIN DENTISTRY PA

Provider Business Mailing Address
First Line	:	135 US HIGHWAY 27 S
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2213
Country	:	US
Telephone Number	:	561-996-0033
Fax Number	:	561-996-0044

Provider Business Practice Location Address
First Line	:	135 US HIGHWAY 27 S
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2213
Country	:	US
Telephone Number	:	561-996-0033
Fax Number	:	561-996-0044

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANTHONY BALDWIN
Credential	:	DDS
Telephone Number	:	561-996-0033

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	01/15/2018

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Directions to “BALDWIN DENTISTRY PA ” Practice Location

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