Provider Demographics
NPI:1326137191
Name:BAXTER, JOHN ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1312
Mailing Address - Country:US
Mailing Address - Phone:913-856-4465
Mailing Address - Fax:913-273-0159
Practice Address - Street 1:206 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1312
Practice Address - Country:US
Practice Address - Phone:913-856-4465
Practice Address - Fax:913-273-0159
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120224821223X0400X
AR1291223X0400X
AR3225122300000X
KS608691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist