Provider Demographics
NPI:1548870942
Name:BAULDRY, AUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:BAULDRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12918 ROSE MARIE DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8797
Mailing Address - Country:US
Mailing Address - Phone:209-405-1247
Mailing Address - Fax:
Practice Address - Street 1:12918 ROSE MARIE DR
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8797
Practice Address - Country:US
Practice Address - Phone:209-405-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist