Provider Demographics
NPI:1134257983
Name:BAXTER, WILLIAM D (DMD,PA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566-3 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4734
Mailing Address - Country:US
Mailing Address - Phone:904-751-4958
Mailing Address - Fax:904-751-5330
Practice Address - Street 1:1566-3 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4734
Practice Address - Country:US
Practice Address - Phone:904-751-4958
Practice Address - Fax:904-751-5330
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice