Provider Demographics
NPI:1871663674
Name:SOFIA J BALTAZAR DDS INC
Entity Type:Organization
Organization Name:SOFIA J BALTAZAR DDS INC
Other - Org Name:TL DENTAL SCALER CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-290-2825
Mailing Address - Street 1:24264 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2911
Mailing Address - Country:US
Mailing Address - Phone:661-290-2825
Mailing Address - Fax:661-290-2864
Practice Address - Street 1:24264 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2911
Practice Address - Country:US
Practice Address - Phone:661-290-2825
Practice Address - Fax:661-290-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4946601OtherDELTA
CAG9255701OtherMEDICAL