Healthcare Provider Details

I. General information

NPI: 1508954504
Provider Name (Legal Business Name): LIDA C. BAQUERO-BARRENECHE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8443 PRESTBURY DR.
ORLANDO FL
32832
US

IV. Provider business mailing address

8443 PRESTBURY DR.
ORLANDO FL
32832
US

V. Phone/Fax

Practice location:
  • Phone: 917-579-7167
  • Fax: 718-357-5545
Mailing address:
  • Phone: 917-579-7167
  • Fax: 718-357-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044872-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: