Healthcare Provider Details

I. General information

NPI: 1093273922
Provider Name (Legal Business Name): JOEL BAEZ, D.M.D, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SE 6TH AVE STE B-1
DELRAY BEACH FL
33483-5264
US

IV. Provider business mailing address

160 SE 6TH AVE STE B-1
DELRAY BEACH FL
33483-5264
US

V. Phone/Fax

Practice location:
  • Phone: 561-276-6684
  • Fax: 561-276-6685
Mailing address:
  • Phone: 561-276-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL BAEZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 561-276-6684