Provider Demographics
NPI:1023633773
Name:BAQUERO NUNEZ, SARA LUCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:LUCIA
Last Name:BAQUERO NUNEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 STIRRUP RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2295
Mailing Address - Country:US
Mailing Address - Phone:704-497-7312
Mailing Address - Fax:
Practice Address - Street 1:10808 MONROE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7305
Practice Address - Country:US
Practice Address - Phone:704-771-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice