Provider Demographics
NPI:1699498451
Name:NORTH BALDWIN DENTISTRY & FACIAL AESTHETICS, PLLC
Entity type:Organization
Organization Name:NORTH BALDWIN DENTISTRY & FACIAL AESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-852-6500
Mailing Address - Street 1:1901 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4112
Mailing Address - Country:US
Mailing Address - Phone:251-937-9501
Mailing Address - Fax:251-937-9869
Practice Address - Street 1:1901 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4112
Practice Address - Country:US
Practice Address - Phone:251-937-9501
Practice Address - Fax:251-937-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1619017845OtherDENTIST
AL1861532012OtherDENTISTRY