Provider Demographics
NPI:1235448804
Name:BAKER, ANGELA PAOLETTO (RDH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PAOLETTO
Last Name:BAKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15076 AUDUBON LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6240
Mailing Address - Country:US
Mailing Address - Phone:228-206-1228
Mailing Address - Fax:
Practice Address - Street 1:15076 AUDUBON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-206-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3863-10DH124Q00000X
GADH009244124Q00000X
IN13006035A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist