Organization
IGNACIO ALBERTO BAEZ DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IGNACIO ALBERTO BAEZ (OWNER)
(407) 310-6627
Entity
Organization
Contact information
Practice address
300 GATLIN AVE, ORLANDO, FL 32806-6951
(407) 310-6627
Mailing address
300 GATLIN AVE, ORLANDO, FL 32806-6951
(407) 310-6627
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN0007199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002854600
—
FL
01
—
075096496
MED WAIVER
FL
Enumeration date
04/14/2016
Last updated
04/14/2016
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