Provider Demographics
NPI:1235332784
Name:BAKER, JAIME KATHLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:KATHLEEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:KATHLEEN
Other - Last Name:STENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2209
Mailing Address - Country:US
Mailing Address - Phone:574-674-8757
Mailing Address - Fax:
Practice Address - Street 1:103 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2209
Practice Address - Country:US
Practice Address - Phone:574-674-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010999A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist