Provider Demographics
NPI:1407076144
Name:BALTZ, PAUL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:BALTZ
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 1:412 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455
Mailing Address - Country:US
Mailing Address - Phone:870-892-4394
Mailing Address - Fax:870-892-9089
Practice Address - Street 1:412 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3423
Practice Address - Country:US
Practice Address - Phone:870-892-4394
Practice Address - Fax:870-892-9089
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice