Healthcare Provider Details

I. General information

NPI: 1851950026
Provider Name (Legal Business Name): DR. ERIN LEIGH BALDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOINT BASE LANGLEY EUSTIS DENTAL CLINIC 76 NEALY AVE
APO AA
23665
US

IV. Provider business mailing address

62 EMORY WAY
HAMPTON VA
23666-4360
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-7630
  • Fax: 757-225-0595
Mailing address:
  • Phone: 308-520-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7536
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: