Provider Demographics
NPI:1154448900
Name:BAKER, REBECCA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:107 FRAZIER CT
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8973
Mailing Address - Country:US
Mailing Address - Phone:502-863-3600
Mailing Address - Fax:502-863-3699
Practice Address - Street 1:107 FRAZIER CT
Practice Address - Street 2:SUITE 2E
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8973
Practice Address - Country:US
Practice Address - Phone:502-863-3600
Practice Address - Fax:502-863-3699
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611448729OtherTAX ID NUMBER