Provider Demographics
NPI:1518275387
Name:BALDWIN, SUZANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
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:PO BOX 11832
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547
Mailing Address - Country:US
Mailing Address - Phone:254-213-6300
Mailing Address - Fax:
Practice Address - Street 1:1711 EAST CENTRAL TEXAS EXPY SUITE 102
Practice Address - Street 2:
Practice Address - City:KILEEN
Practice Address - State:TX
Practice Address - Zip Code:76541
Practice Address - Country:US
Practice Address - Phone:254-213-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist