Provider Demographics
NPI:1225069172
Name:BALDIVIEZ, CAROLYN RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:RENEE
Last Name:BALDIVIEZ
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 1:111 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6625
Mailing Address - Country:US
Mailing Address - Phone:805-925-8112
Mailing Address - Fax:805-347-7703
Practice Address - Street 1:111 E PARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6625
Practice Address - Country:US
Practice Address - Phone:805-925-8112
Practice Address - Fax:805-347-7703
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432901223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice