Provider Demographics
NPI:1164155529
Name:BALDWIN, GLENN CHRISTOPHER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:CHRISTOPHER
Last Name:BALDWIN
Suffix:JR
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 1:120 CONNER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7092
Mailing Address - Country:US
Mailing Address - Phone:919-960-0155
Mailing Address - Fax:
Practice Address - Street 1:120 CONNER DR STE 201
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7092
Practice Address - Country:US
Practice Address - Phone:919-960-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice