Provider Demographics
NPI:1104868090
Name:BAKER, MARTHA CHRISTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:CHRISTINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MAIN ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3515
Mailing Address - Country:US
Mailing Address - Phone:631-878-7106
Mailing Address - Fax:631-878-7124
Practice Address - Street 1:234 MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3515
Practice Address - Country:US
Practice Address - Phone:631-878-7106
Practice Address - Fax:631-878-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041005-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice