MEDICARE: ALEJANDRO JOSE BAEZ GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN060602	NY
2	1223P0300X	Periodontics	DN28929	FL
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28929	OTHER	FL	FLORIDA DENTAL LICENSE
2	060602	OTHER	NY	NY DENTAL LICENSE

General Provider Information

NPI Number	:	1114420627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO JOSE BAEZ GUTIERREZ

Provider Business Mailing Address
First Line	:	201 N LAKEMONT AVE STE 700
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3200
Country	:	US
Telephone Number	:	407-629-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 S UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-2234
Country	:	US
Telephone Number	:	954-431-0004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2018
Last Update Date	:	12/11/2025

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Directions to “ ALEJANDRO JOSE BAEZ GUTIERREZ ” Practice Location

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