Provider Demographics
NPI:1841317369
Name:STEPHANIE J. BALDWIN, D.D.S., P.A.
Entity type:Organization
Organization Name:STEPHANIE J. BALDWIN, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-623-4433
Mailing Address - Street 1:1911 MALVERN AVE.
Mailing Address - Street 2:STE. B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7753
Mailing Address - Country:US
Mailing Address - Phone:501-623-4433
Mailing Address - Fax:501-623-4334
Practice Address - Street 1:1911 MALVERN AVE.
Practice Address - Street 2:STE. B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7753
Practice Address - Country:US
Practice Address - Phone:501-623-4433
Practice Address - Fax:501-623-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163102631Medicaid