Provider Demographics
NPI:1821637497
Name:LIDA C. BAQUERO-BARRENECHE DDS, PLLC
Entity Type:Organization
Organization Name:LIDA C. BAQUERO-BARRENECHE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAQUERO-BARRENECHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-357-5545
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:718-357-7845
Mailing Address - Fax:
Practice Address - Street 1:4207 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2735
Practice Address - Country:US
Practice Address - Phone:718-357-5545
Practice Address - Fax:718-357-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental