Provider Demographics
NPI:1235280637
Name:BAKER, BRIAN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4734
Mailing Address - Country:US
Mailing Address - Phone:321-267-7072
Mailing Address - Fax:321-267-4948
Practice Address - Street 1:1625 S WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4734
Practice Address - Country:US
Practice Address - Phone:321-267-7072
Practice Address - Fax:321-267-4948
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00128611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice