Provider Demographics
NPI:1073066551
Name:BALDWIN, ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33493-2213
Mailing Address - Country:US
Mailing Address - Phone:786-838-5234
Mailing Address - Fax:
Practice Address - Street 1:135 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SOUTH BAY
Practice Address - State:FL
Practice Address - Zip Code:33493-2213
Practice Address - Country:US
Practice Address - Phone:561-996-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018929800Medicaid