Provider Demographics
NPI:1568675395
Name:DAVID R. BALDARE DDS LTD
Entity Type:Organization
Organization Name:DAVID R. BALDARE DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-392-3122
Mailing Address - Street 1:15 S DRYDEN PL STE D
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6369
Mailing Address - Country:US
Mailing Address - Phone:847-392-3122
Mailing Address - Fax:847-392-3178
Practice Address - Street 1:15 S DRYDEN PL STE D
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6369
Practice Address - Country:US
Practice Address - Phone:847-392-3122
Practice Address - Fax:847-392-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty