Provider Demographics
NPI:1063658607
Name:BAKER, MATTHEW STEVEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 N HONORE AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2606
Mailing Address - Country:US
Mailing Address - Phone:941-355-3808
Mailing Address - Fax:
Practice Address - Street 1:5911 N HONORE AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2606
Practice Address - Country:US
Practice Address - Phone:941-355-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-04
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL177671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics