Provider Demographics
NPI:1053085191
Name:BAIDOO, ADWOA BOATENG
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:BOATENG
Last Name:BAIDOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 CONSTITUTION CT
Mailing Address - Street 2:APT 102
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:703-206-8504
Mailing Address - Fax:
Practice Address - Street 1:4100 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8797
Practice Address - Country:US
Practice Address - Phone:703-206-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401417571OtherDENTAL LICENSE NUMBER