Provider Demographics
NPI:1831695410
Name:BALDOCK, WILLIAM JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BALDOCK
Suffix:JR
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 1:2621 MITCHAM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5481
Mailing Address - Country:US
Mailing Address - Phone:850-942-8111
Mailing Address - Fax:850-942-8114
Practice Address - Street 1:2621 MITCHAM DR STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5481
Practice Address - Country:US
Practice Address - Phone:850-942-8111
Practice Address - Fax:850-942-8114
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN235321223P0300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0300XDental ProvidersDentistPeriodontics