Provider Demographics
NPI:1689167082
Name:BAQUERO NUNEZ, CARLOS JOSE (DMD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:BAQUERO NUNEZ
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 1:2331 CROWNPOINT EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7749
Mailing Address - Country:US
Mailing Address - Phone:704-704-4744
Mailing Address - Fax:
Practice Address - Street 1:2331 CROWNPOINT EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7749
Practice Address - Country:US
Practice Address - Phone:704-704-4744
Practice Address - Fax:704-973-0902
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice