MEDICARE: DR. SERGIO M BARON QUIROGA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.033252	IL
2	1223G0001X	General Practice Dentistry	DN28132	FL

General Provider Information

NPI Number	:	1518530435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO M BARON QUIROGA DDS

Provider Business Mailing Address
First Line	:	1416 STROUD CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4276
Country	:	US
Telephone Number	:	786-656-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 STROUD CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4276
Country	:	US
Telephone Number	:	786-656-6640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	11/27/2023

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