Provider Demographics
NPI:1083839088
Name:BAKER, MELANIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W MAIN ST
Mailing Address - Street 2:STE 6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6929
Mailing Address - Country:US
Mailing Address - Phone:480-838-4185
Mailing Address - Fax:
Practice Address - Street 1:1911 W MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6929
Practice Address - Country:US
Practice Address - Phone:480-838-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5281124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist