MEDICARE: MAUREEN MARIE BALDZICKI 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	30.028006	OH
2	122300000X	Dentist	30.028006	OH

General Provider Information

NPI Number	:	1598558553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN MARIE BALDZICKI DDS

Provider Business Mailing Address
First Line	:	6847 BRAMBLEWOOD LN
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-1579
Country	:	US
Telephone Number	:	216-598-0994
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 SOM CENTER RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3540
Country	:	US
Telephone Number	:	440-442-4100
Fax Number	:

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

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	05/23/2025

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