Provider Demographics
NPI:1699174623
Name:BAEZ, VALENTINA (DMD)
Entity type:Individual
Prefix:DR
First Name:VALENTINA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VALENTINA
Other - Middle Name:DEL VALLE
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 SE 6TH AVE # B1
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5264
Mailing Address - Country:US
Mailing Address - Phone:561-276-6684
Mailing Address - Fax:
Practice Address - Street 1:160 SE 6TH AVE # B1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-276-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20502122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics