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General NPI Number Information
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NPI Number | 1427419563
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Entity Type | Organization
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Legal Business Name | BALDWIN DENTAL ARTS PLLC
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 1700 GRAND AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1801
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Country | US
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Telephone | 516-379-3204
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Fax | 516-379-3209
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Provider Business Mailing Address
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Address Line | 1700 GRAND AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1801
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Country | US
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Telephone | 516-379-3204
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Fax | 516-379-3209
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ALICIA F ANDREULA
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Credential | 054033
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Telephone | 917-418-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 032402
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 054033
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License Number State | NY
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