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General NPI Number Information
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NPI Number | 1477047843
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Entity Type | Individual
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Provider Name | FELICIA BALTAZAR DDS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 7 HADLEY ST STE 9
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City | SOUTH HADLEY
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State | MA
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Zip | 01075-1058
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Country | US
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Telephone | 413-538-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 113 GULF RD
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City | BELCHERTOWN
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State | MA
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Zip | 01007-9353
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Country | US
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Telephone | 413-262-9534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1858045
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License Number State | MA
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