Provider Demographics
NPI:1104045996
Name:DR. D.O. BAXTER P.C.
Entity Type:Organization
Organization Name:DR. D.O. BAXTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BAXTER
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-867-4175
Mailing Address - Street 1:152 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8200
Mailing Address - Country:US
Mailing Address - Phone:770-867-4175
Mailing Address - Fax:770-868-1564
Practice Address - Street 1:152 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8200
Practice Address - Country:US
Practice Address - Phone:770-867-4175
Practice Address - Fax:770-868-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty