Provider Demographics
NPI:1508954504
Name:BAQUERO-BARRENECHE, LIDA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIDA
Middle Name:C
Last Name:BAQUERO-BARRENECHE
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 1:17128 COURTNEY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3812
Mailing Address - Country:US
Mailing Address - Phone:718-357-5545
Mailing Address - Fax:718-357-5545
Practice Address - Street 1:17128 COURTNEY AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3812
Practice Address - Country:US
Practice Address - Phone:718-357-5545
Practice Address - Fax:718-357-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044872-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice