Provider Demographics
NPI:1003920505
Name:BAKER, ALAN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CIMARRON TRL
Mailing Address - Street 2:STE. 3
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3439
Mailing Address - Country:US
Mailing Address - Phone:817-280-0099
Mailing Address - Fax:817-280-0377
Practice Address - Street 1:1725 CIMARRON TRL
Practice Address - Street 2:STE. 3
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3439
Practice Address - Country:US
Practice Address - Phone:817-280-0099
Practice Address - Fax:817-280-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice