Provider Demographics
NPI:1376742619
Name:BALDWIN, DIANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
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 1:3824 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2054
Mailing Address - Country:US
Mailing Address - Phone:732-202-7114
Mailing Address - Fax:732-202-7191
Practice Address - Street 1:621 MYERS RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8800
Practice Address - Country:US
Practice Address - Phone:843-594-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI234921223P0221X
SC96671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry