Provider Demographics
NPI:1508873258
Name:BAEZ, PEDRO ANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ANGEL
Last Name:BAEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6814
Mailing Address - Country:US
Mailing Address - Phone:787-473-3209
Mailing Address - Fax:903-242-9778
Practice Address - Street 1:1499 E. MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4655
Practice Address - Country:US
Practice Address - Phone:787-878-3036
Practice Address - Fax:903-242-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1829122300000X
TX27948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27948Medicaid