MEDICARE: ERIDANIA BAEZ 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	052104-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851591184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIDANIA BAEZ DDS

Provider Business Mailing Address
First Line	:	1411 MERRY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-6025
Country	:	US
Telephone Number	:	212-866-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 MERRY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-6025
Country	:	US
Telephone Number	:	212-866-1313
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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