Provider Demographics
NPI:1841812633
Name:BALDWIN, DANA ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ELIZABETH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SUNNYSIDE DR APT 105
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5657
Mailing Address - Country:US
Mailing Address - Phone:608-658-2966
Mailing Address - Fax:
Practice Address - Street 1:1831 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8757
Practice Address - Country:US
Practice Address - Phone:608-783-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10022721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice