Provider Demographics
NPI:1154631364
Name:GREG R. BAKER DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:GREG R. BAKER DENTAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-435-7676
Mailing Address - Street 1:145 CITIZENS LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1320
Mailing Address - Country:US
Mailing Address - Phone:606-435-7676
Mailing Address - Fax:606-436-5175
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9421
Practice Address - Country:US
Practice Address - Phone:606-439-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60063229Medicaid