MEDICARE: DR. DIANE BALDWIN D.M.D

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	1223P0221X	Pediatric Dentistry	DI23492	NJ
2	1223P0221X	Pediatric Dentistry	9667	SC

General Provider Information

NPI Number	:	1376742619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE BALDWIN D.M.D

Provider Business Mailing Address
First Line	:	3824 RIVER RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-2054
Country	:	US
Telephone Number	:	732-202-7114
Fax Number	:	732-202-7191

Provider Business Practice Location Address
First Line	:	621 MYERS RD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-8800
Country	:	US
Telephone Number	:	843-594-5237
Fax Number	:

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	04/25/2024

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