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General NPI Number Information
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NPI Number | 1639016959
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Entity Type | Organization
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Legal Business Name | DR CAROLYN R BALDIVIEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 111 E PARK AVE
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City | SANTA MARIA
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State | CA
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Zip | 93454-6625
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Country | US
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Telephone | 805-925-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E PARK AVE
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City | SANTA MARIA
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State | CA
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Zip | 93454-6625
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Country | US
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Telephone | 805-925-8112
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLYN R BALDIVIEZ
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Credential | DDS
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Telephone | 805-925-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 |
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License Number State |
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