Provider Demographics
NPI:1396518981
Name:BALDWIN, MONICA ANN (RDH)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ANN
Other - Last Name:FANANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:40319 W BEACH LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-9534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40319 W BEACH LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9534
Practice Address - Country:US
Practice Address - Phone:224-636-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020014511124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist