Provider Demographics
NPI:1508951831
Name:BAEZ, IGNACIO ALBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:ALBERTO
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 1:300 GATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6951
Mailing Address - Country:US
Mailing Address - Phone:407-438-3777
Mailing Address - Fax:407-438-3723
Practice Address - Street 1:300 GATLIN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6951
Practice Address - Country:US
Practice Address - Phone:407-438-3777
Practice Address - Fax:407-438-3723
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00071991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075096496Medicaid