Provider Demographics
NPI:1770229023
Name:SOUTH BALDWIN DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH BALDWIN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERCROMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-943-1521
Mailing Address - Street 1:101 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1478
Mailing Address - Country:US
Mailing Address - Phone:125-194-3152
Mailing Address - Fax:
Practice Address - Street 1:101 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1478
Practice Address - Country:US
Practice Address - Phone:125-194-3152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty