Healthcare Provider Details

I. General information

NPI: 1639016959
Provider Name (Legal Business Name): DR CAROLYN R BALDIVIEZ DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E PARK AVE
SANTA MARIA CA
93454-6625
US

IV. Provider business mailing address

111 E PARK AVE
SANTA MARIA CA
93454-6625
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-8112
  • Fax:
Mailing address:
  • Phone: 805-925-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN R BALDIVIEZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 805-925-8112