Provider Demographics
NPI:1861736407
Name:BALDWIN COUNTY ENDODONTICS, PC
Entity type:Organization
Organization Name:BALDWIN COUNTY ENDODONTICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-928-4510
Mailing Address - Street 1:921 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2949
Mailing Address - Country:US
Mailing Address - Phone:251-928-4510
Mailing Address - Fax:251-928-0045
Practice Address - Street 1:921 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2949
Practice Address - Country:US
Practice Address - Phone:251-928-4510
Practice Address - Fax:251-928-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty