Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 016.0129953 | VT |
N | 1223G0001X | General Practice | 0129953 | VT |
N | 213EG0000X | General Practice | 0129953 | VT |
NPI | 1003279290 |
---|---|
Provider Name | Ms. Riley Baldwin |
First Address | Waterbury, VT 05676-1555 |
Second Address | Winooski, VT 05404-1316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 17/03/2018 |