# PHILIP BALD WATERFORD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Center at Waterford
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154695112
- **Authorized official:** DR. PHILIP FRANCIS BALD DMD (DENTIST-MEMBER MANAGER)
- **Authorized official phone:** (910) 202-4909

## Contact information

- **Practice address:** 509 OLDE WATERFORD WAY, SUITE 300, LELAND, ND 28451-4171
- **Practice address phone:** (910) 383-0100
- **Practice address fax:** (910) 383-0121
- **Mailing address:** 509 OLDE WATERFORD WAY, SUITE 300, LELAND, NC 28451-4171
- **Mailing address phone:** (910) 383-0100
- **Mailing address fax:** (910) 383-0121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8308 | NC | Yes |

## Other

- **Enumeration date:** 03/08/2012
- **Last updated:** 03/08/2012