Provider Demographics
NPI:1902194079
Name:BALDWIN, KEVIN DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DEAN
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 NOSTALGIA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1023
Mailing Address - Country:US
Mailing Address - Phone:614-599-9677
Mailing Address - Fax:
Practice Address - Street 1:8670 W CHEYENNE AVE STE 205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7457
Practice Address - Country:US
Practice Address - Phone:702-360-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9586122300000X
NV6402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist