Provider Demographics
NPI:1518530435
Name:BARON QUIROGA, SERGIO M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:M
Last Name:BARON QUIROGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 STROUD CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4276
Mailing Address - Country:US
Mailing Address - Phone:786-656-6640
Mailing Address - Fax:
Practice Address - Street 1:1416 STROUD CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4276
Practice Address - Country:US
Practice Address - Phone:786-656-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0332521223G0001X
FLDN281321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice