Healthcare Provider Details

I. General information

NPI: 1356431977
Provider Name (Legal Business Name): JILL SUSAN BALDINGER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 SUFFOLK RD. SUITE B
FINKSBURG MD
21048
US

IV. Provider business mailing address

1207 HARBOR ISLAND WALK
BALTIMORE MD
21230-5461
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-3001
  • Fax: 410-861-8744
Mailing address:
  • Phone: 410-534-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: