Provider Demographics
NPI:1255372801
Name:BALDWIN, CREIGHTON WILBUR (DMD)
Entity type:Individual
Prefix:DR
First Name:CREIGHTON
Middle Name:WILBUR
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 GLENWATER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8592
Mailing Address - Country:US
Mailing Address - Phone:704-154-7119
Mailing Address - Fax:704-549-4699
Practice Address - Street 1:9010 GLENWATER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8592
Practice Address - Country:US
Practice Address - Phone:704-154-7119
Practice Address - Fax:704-549-4699
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990383Medicare ID - Type Unspecified