Provider Demographics
NPI:1003817271
Name:BAKER, SUSAN MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E SNOW CANYON PKWY UNIT 402
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6818
Mailing Address - Country:US
Mailing Address - Phone:435-341-0028
Mailing Address - Fax:435-656-4623
Practice Address - Street 1:1215 E SNOW CANYON PKWY UNIT 402
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6818
Practice Address - Country:US
Practice Address - Phone:435-341-0028
Practice Address - Fax:435-703-9960
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9648122300000X
UT6413406-99221223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist