Provider Demographics
NPI:1295907285
Name:CENTRAL BALDWIN DENTAL CENTER, P.C.
Entity type:Organization
Organization Name:CENTRAL BALDWIN DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-947-5940
Mailing Address - Street 1:18100 HWY 104
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-8734
Mailing Address - Country:US
Mailing Address - Phone:251-947-5940
Mailing Address - Fax:251-947-5942
Practice Address - Street 1:18100 HIGHWAY 104
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-8734
Practice Address - Country:US
Practice Address - Phone:251-947-5940
Practice Address - Fax:251-947-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty