Provider Demographics
NPI:1467463315
Name:BALDOCK, WILLIAM T (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:BALDOCK
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 MITCHAM DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5480
Mailing Address - Country:US
Mailing Address - Phone:850-942-8111
Mailing Address - Fax:850-942-8114
Practice Address - Street 1:2621 MITCHAM DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5480
Practice Address - Country:US
Practice Address - Phone:850-942-8111
Practice Address - Fax:850-942-8114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85524OtherBLUE CROSS BLUE SHIELD
FL145069OtherUNITED CONCORDIA