Provider Demographics
NPI:1124207899
Name:BRUCE A. BAKER, D.D.S., P.A.
Entity Type:Organization
Organization Name:BRUCE A. BAKER, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-443-2994
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0002
Mailing Address - Country:US
Mailing Address - Phone:952-443-2994
Mailing Address - Fax:952-443-2918
Practice Address - Street 1:1405 78TH ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-9723
Practice Address - Country:US
Practice Address - Phone:952-443-2994
Practice Address - Fax:952-443-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty