Provider Demographics
NPI:1376124750
Name:BALDWIN, TAYLOR SIMONE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:SIMONE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CATESBY TRL APT 200
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4492
Mailing Address - Country:US
Mailing Address - Phone:336-567-5522
Mailing Address - Fax:
Practice Address - Street 1:545 US 70 HWY E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4046
Practice Address - Country:US
Practice Address - Phone:919-804-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-18
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123201223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program