Provider Demographics
NPI:1114420627
Name:BAEZ GUTIERREZ, ALEJANDRO JOSE
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JOSE
Last Name:BAEZ GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3200
Mailing Address - Country:US
Mailing Address - Phone:407-629-6400
Mailing Address - Fax:
Practice Address - Street 1:201 N LAKEMONT AVE STE 700
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3200
Practice Address - Country:US
Practice Address - Phone:407-629-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060602122300000X
390200000X
FL289291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28929OtherFLORIDA DENTAL LICENSE
NY060602OtherNY DENTAL LICENSE