Provider Demographics
NPI:1184756330
Name:BALDWIN, BRUCE GORDON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GORDON
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 1:13701 W JEWELL AVE
Mailing Address - Street 2:#101
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4172
Mailing Address - Country:US
Mailing Address - Phone:303-989-3192
Mailing Address - Fax:720-962-9259
Practice Address - Street 1:13701 W JEWELL AVE
Practice Address - Street 2:#101
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4172
Practice Address - Country:US
Practice Address - Phone:303-989-3192
Practice Address - Fax:720-962-9259
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist