Provider Demographics
NPI:1134493745
Name:BAKI, RAJA
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:BAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 STATE HIGHWAY 161 STE 198
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2880
Mailing Address - Country:US
Mailing Address - Phone:972-869-3789
Mailing Address - Fax:972-869-3791
Practice Address - Street 1:7301 STATE HIGHWAY 161 STE 198
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2880
Practice Address - Country:US
Practice Address - Phone:972-869-3789
Practice Address - Fax:972-869-3791
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice