=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558430702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. FRANCIS A. BALD AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2224 S CROATAN HWY SUITE 7
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-441-4300
-----------------------------------------------------
Fax | 252-441-6684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2224 S CROATAN HWY SUITE 7
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-441-4300
-----------------------------------------------------
Fax | 252-441-6684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ORAL SURGEON
-----------------------------------------------------
Name | DR. FRANCIS A BALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-441-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 4745
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------