Provider Demographics
NPI:1336289131
Name:BALDWIN, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3286 GA HIGHWAY 266
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-5100
Mailing Address - Country:US
Mailing Address - Phone:292-869-7341
Mailing Address - Fax:
Practice Address - Street 1:505 FORRESTER DR SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-2006
Practice Address - Country:US
Practice Address - Phone:229-995-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20830124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20830OtherREGISTERED DENTAL HYGIENS
GADH012000OtherREGISTERED DENTAL HYGIENIST