Provider Demographics
NPI:1396886677
Name:BALDASSANO, JOSEPH VINCENT (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:BALDASSANO
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 COLONIAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4725
Mailing Address - Country:US
Mailing Address - Phone:847-359-6979
Mailing Address - Fax:847-359-6980
Practice Address - Street 1:1616 COLONIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4725
Practice Address - Country:US
Practice Address - Phone:847-359-6979
Practice Address - Fax:847-359-6980
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics