Kingsley E Baldwin III
Individual provider Active NPI General Practice Dentistry · Boardman, OH
NPI 1205908183 · NPPES record last updated Oct 31, 2016
Key facts
- NPI
- 1205908183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 30-022397 (OH)
- Practice address
- 6540 South Ave
Boardman, OH 44512-3651 - Phone
- (330) 758-5547
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20160210000681 | OH | Order and Referring Only - Dentist |
4284938341 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-022397 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30-022397 | OH | Yes |
Addresses
Primary practice location
6540 South Ave
Boardman, OH 44512-3651
Mailing address
6540 South Ave
Boardman, OH 44512-3651
Phone (330) 758-5547
Other providers in Boardman, OH
- Yacoub Baghdy
- Lisa Baglieri
- Brent Baisch
- Catherine Susan Baker
- Robert S Bakondy
- Shelby Ball
- Joseph Ballone II
- Kyle Banna
- Jessica Lynn Barat
- Brendan Michael Barrett
All providers in Boardman, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2016. 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.