Provider Demographics
NPI:1013172899
Name:BALDAWI, ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:BALDAWI
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 1:6923 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-3709
Mailing Address - Country:US
Mailing Address - Phone:619-756-0401
Mailing Address - Fax:
Practice Address - Street 1:26938 THE OLD RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91381-0662
Practice Address - Country:US
Practice Address - Phone:619-756-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice