Provider Demographics
NPI:1003279290
Name:BALDWIN, RILEY (DMD)
Entity Type:Individual
Prefix:MS
First Name:RILEY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1555
Mailing Address - Country:US
Mailing Address - Phone:413-329-7824
Mailing Address - Fax:
Practice Address - Street 1:61 SAINT PETER ST # B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1316
Practice Address - Country:US
Practice Address - Phone:413-329-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01299531223G0001X
VT016.0129953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice