Provider Demographics
NPI:1003034372
Name:BAEZ, JESSICA MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:BAEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26615 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1968
Mailing Address - Country:US
Mailing Address - Phone:281-296-8600
Mailing Address - Fax:281-296-9509
Practice Address - Street 1:25300 BOROUGH PARK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3552
Practice Address - Country:US
Practice Address - Phone:281-296-0052
Practice Address - Fax:281-296-0118
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228451223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics