Provider Demographics
NPI:1427419563
Name:BALDWIN DENTAL ARTS PLLC
Entity Type:Organization
Organization Name:BALDWIN DENTAL ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDREULA
Authorized Official - Suffix:
Authorized Official - Credentials:054033
Authorized Official - Phone:917-418-8384
Mailing Address - Street 1:1700 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1801
Mailing Address - Country:US
Mailing Address - Phone:516-379-3204
Mailing Address - Fax:516-379-3209
Practice Address - Street 1:1700 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1801
Practice Address - Country:US
Practice Address - Phone:516-379-3204
Practice Address - Fax:516-379-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054033122300000X
NY032402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty