MEDICARE: BALDWIN WILFRED MARCHACK D.D.S.

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	1223G0001X	General Practice Dentistry	21919	CA

General Provider Information

NPI Number	:	1619136363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALDWIN WILFRED MARCHACK D.D.S.

Provider Business Mailing Address
First Line	:	566 EL DORADO ST STE 200
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2506
Country	:	US
Telephone Number	:	626-793-6700
Fax Number	:	626-793-8777

Provider Business Practice Location Address
First Line	:	566 EL DORADO ST STE 200
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2506
Country	:	US
Telephone Number	:	626-793-6700
Fax Number	:	626-793-8777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2008
Last Update Date	:	08/14/2024

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