MEDICARE: ALLAN BALDAWI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	57135	CA

General Provider Information

NPI Number	:	1013172899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN BALDAWI DDS

Provider Business Mailing Address
First Line	:	6923 E GAGE AVE
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-3709
Country	:	US
Telephone Number	:	619-756-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	26938 THE OLD RD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-0662
Country	:	US
Telephone Number	:	619-756-0401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	11/03/2011

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