Provider Demographics
NPI:1073868949
Name:BAKER, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:1440 BEACON ST
Mailing Address - Street 2:APT 402
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2092
Mailing Address - Country:US
Mailing Address - Phone:617-874-0004
Mailing Address - Fax:
Practice Address - Street 1:540 TREMONT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6339
Practice Address - Country:US
Practice Address - Phone:617-357-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist