Mariah Kathlyn Baldwin, DMD
Individual provider Active NPI Dentist · Medford, OR
NPI 1174107478 · NPPES record last updated Jun 6, 2023
Key facts
- NPI
- 1174107478
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D11791 (OR)
- Practice address
- 1113 Progress Dr
Medford, OR 97504 - Phone
- (541) 512-3900
- NPI assigned
- May 12, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230724001269 | OR | Order and Referring Only - Dentist |
8123420122 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11791 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica del Valle Family Health Care Center Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS-09880 | IA | |
| Dentist | 122300000X | D11791 | OR | Yes |
Addresses
Primary practice location
1113 Progress Dr
Medford, OR 97504
Mailing address
931 Chevy Way
Medford, OR 97504-4127
Phone (541) 535-6239
Other practice location 1
33 4th St NW
Sioux Center, IA 51250-1870
Phone (712) 722-1700
Other practice location 2
4940 Hamrick Rd
Central Point, OR 97502
Phone (541) 512-3900
Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.