Healthcare Provider Details

I. General information

NPI: 1427566223
Provider Name (Legal Business Name): BALDWIN DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 US HIGHWAY 27 S
SOUTH BAY FL
33493-2213
US

IV. Provider business mailing address

135 US HIGHWAY 27 S
SOUTH BAY FL
33493-2213
US

V. Phone/Fax

Practice location:
  • Phone: 561-996-0033
  • Fax: 561-996-0044
Mailing address:
  • Phone: 561-996-0033
  • Fax: 561-996-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN21975
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY BALDWIN
Title or Position: DENTIST
Credential: DDS
Phone: 561-996-0033