Provider Demographics
NPI:1417028945
Name:LOREN D. BALDUS, D.M.D., P.A.
Entity Type:Organization
Organization Name:LOREN D. BALDUS, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALDUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-548-6161
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-0327
Mailing Address - Country:US
Mailing Address - Phone:207-548-6161
Mailing Address - Fax:207-548-2132
Practice Address - Street 1:#9 MT. EPHRAIM ROAD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974
Practice Address - Country:US
Practice Address - Phone:207-548-6161
Practice Address - Fax:207-548-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2528OtherME LICENSE #
ME2528OtherME LICENSE #