Provider Demographics
NPI:1164783841
Name:ALBERT BAAWO JR DMD PC
Entity Type:Organization
Organization Name:ALBERT BAAWO JR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAAWO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-355-6088
Mailing Address - Street 1:3280 HOWELL MILL RD NW
Mailing Address - Street 2:EAST WING SUITE 315
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4111
Mailing Address - Country:US
Mailing Address - Phone:404-355-6088
Mailing Address - Fax:404-529-4119
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:EAST WING SUITE 315
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-355-6088
Practice Address - Fax:404-529-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty