Healthcare Provider Details

I. General information

NPI: 1396886677
Provider Name (Legal Business Name): JOSEPH VINCENT BALDASSANO DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 COLONIAL PARKWAY
INVERNESS IL
60067-4725
US

IV. Provider business mailing address

1616 COLONIAL PARKWAY
INVERNESS IL
60067-4725
US

V. Phone/Fax

Practice location:
  • Phone: 847-359-6979
  • Fax: 847-359-6980
Mailing address:
  • Phone: 847-359-6979
  • Fax: 847-359-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: