Provider Demographics
NPI:1831351188
Name:BALDONE DENTISTRY PC
Entity type:Organization
Organization Name:BALDONE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-907-3004
Mailing Address - Street 1:8000 LIBERY PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-970-3004
Mailing Address - Fax:
Practice Address - Street 1:8000 LIBERY PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-970-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4140OtherDENTAL LICENSE NUMBER