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General NPI Number Information
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NPI Number | 1811178379
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Entity Type | Organization
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Legal Business Name | BALDWIN DENTAL
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 1230 MANN DR
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City | MATTHEWS
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State | NC
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Zip | 28105-5535
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Country | US
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Telephone | 704-845-5538
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Fax | 704-847-6508
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Provider Business Mailing Address
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Address Line | 1230 MANN DR
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City | MATTHEWS
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State | NC
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Zip | 28105-5535
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Country | US
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Telephone | 704-845-5538
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Fax | 704-847-6508
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CREIGHTON W. BALDWIN
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Credential |
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Telephone | 704-845-5538
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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 | 4316
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License Number State | NC
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