Provider Demographics
NPI:1265985642
Name:CAROLYN R BALDIVIEZ D D S INC
Entity type:Organization
Organization Name:CAROLYN R BALDIVIEZ D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALDIVIEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-925-8112
Mailing Address - Street 1:111 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6625
Mailing Address - Country:US
Mailing Address - Phone:805-925-8112
Mailing Address - Fax:
Practice Address - Street 1:111 E PARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6625
Practice Address - Country:US
Practice Address - Phone:805-925-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty