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General NPI Number Information
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NPI Number | 1861736407
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Entity Type | Organization
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Legal Business Name | BALDWIN COUNTY ENDODONTICS, PC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 921 PLANTATION BLVD
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City | FAIRHOPE
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State | AL
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Zip | 36532-2949
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Country | US
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Telephone | 251-928-4510
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Fax | 251-928-0045
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Provider Business Mailing Address
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Address Line | 921 PLANTATION BLVD
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City | FAIRHOPE
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State | AL
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Zip | 36532-2949
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Country | US
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Telephone | 251-928-4510
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Fax | 251-928-0045
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER S MCMANUS
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Credential | DMD
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Telephone | 251-928-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4586
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License Number State | AL
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