Provider Demographics
NPI:1578603726
Name:BAEZ, EBLESS V (DMD)
Entity Type:Individual
Prefix:DR
First Name:EBLESS
Middle Name:V
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 1:2067 CALLE DRAMA
Mailing Address - Street 2:URB.SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1810
Mailing Address - Country:US
Mailing Address - Phone:787-844-0233
Mailing Address - Fax:
Practice Address - Street 1:2067 CALLE DRAMA
Practice Address - Street 2:URB.SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1810
Practice Address - Country:US
Practice Address - Phone:787-844-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist