Provider Demographics
NPI:1134289382
Name:BAKER, REGINALD TORRANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:TORRANCE
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 1:2235 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2539
Mailing Address - Country:US
Mailing Address - Phone:773-493-4937
Mailing Address - Fax:773-675-4419
Practice Address - Street 1:8803 SOUTH STONY ISLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2810
Practice Address - Country:US
Practice Address - Phone:773-375-0303
Practice Address - Fax:773-375-9018
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0251661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1665557Medicaid