MEDICARE: CARLOS JOSE BAQUERO NUNEZ DMD

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	11067	NC

General Provider Information

NPI Number	:	1689167082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS JOSE BAQUERO NUNEZ DMD

Provider Business Mailing Address
First Line	:	2331 CROWNPOINT EXECUTIVE DR STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7749
Country	:	US
Telephone Number	:	704-704-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 CROWNPOINT EXECUTIVE DR STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7749
Country	:	US
Telephone Number	:	704-704-4744
Fax Number	:	704-973-0902

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/11/2018

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