Provider Demographics
NPI:1760896138
Name:BALDWIN, RICHARD ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:BALDWIN
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 1:3435 E PONY EXPRESS PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6033
Mailing Address - Country:US
Mailing Address - Phone:801-877-0780
Mailing Address - Fax:801-903-1112
Practice Address - Street 1:3435 E PONY EXPRESS PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-8400
Practice Address - Country:US
Practice Address - Phone:801-310-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4097122300000X
UT9441831-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist