Provider Demographics
NPI:1114110152
Name:BAXTER, TRUMAN D (DDS)
Entity Type:Individual
Prefix:MR
First Name:TRUMAN
Middle Name:D
Last Name:BAXTER
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 1:2021 PLEASURE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2709
Mailing Address - Country:US
Mailing Address - Phone:757-464-3514
Mailing Address - Fax:757-460-7815
Practice Address - Street 1:2021 PLEASURE HOUSE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2709
Practice Address - Country:US
Practice Address - Phone:757-464-3514
Practice Address - Fax:757-460-7815
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA31981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice