Provider Demographics
NPI:1750453288
Name:BALDUS, LOREN D (DMD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:D
Last Name:BALDUS
Suffix:
Gender:M
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 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:04974-0327
Practice Address - Country:US
Practice Address - Phone:207-548-6161
Practice Address - Fax:207-548-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132300000Medicaid
ME2528OtherME LICENSE #