Provider Demographics
NPI:1144797994
Name:BAKER DENTAL GROUP PC
Entity Type:Organization
Organization Name:BAKER DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-554-5290
Mailing Address - Street 1:1128 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9040
Mailing Address - Country:US
Mailing Address - Phone:630-554-5290
Mailing Address - Fax:630-554-5152
Practice Address - Street 1:1128 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9040
Practice Address - Country:US
Practice Address - Phone:630-554-5290
Practice Address - Fax:630-554-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty