Provider Demographics
NPI:1154443182
Name:L. BRADLEY BAKER, DMD, PSC
Entity Type:Organization
Organization Name:L. BRADLEY BAKER, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-684-7433
Mailing Address - Street 1:1300 SOUTHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7481
Mailing Address - Country:US
Mailing Address - Phone:270-684-7433
Mailing Address - Fax:270-685-4114
Practice Address - Street 1:1300 SOUTHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7481
Practice Address - Country:US
Practice Address - Phone:270-684-7433
Practice Address - Fax:270-685-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY61871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty