Provider Demographics
NPI:1174675490
Name:BAKER, BRIUCE BOUNDS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIUCE
Middle Name:BOUNDS
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2525
Mailing Address - Country:US
Mailing Address - Phone:740-687-6105
Mailing Address - Fax:740-687-0399
Practice Address - Street 1:611 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2525
Practice Address - Country:US
Practice Address - Phone:740-687-6105
Practice Address - Fax:740-687-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice