Provider Demographics
NPI:1356499644
Name:BAKER, BRUCE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:B
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13422 POMERADO RD
Mailing Address - Street 2:STE #201
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3548
Mailing Address - Country:US
Mailing Address - Phone:858-679-6660
Mailing Address - Fax:858-679-8580
Practice Address - Street 1:13422 POMERADO RD
Practice Address - Street 2:STE #201
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3548
Practice Address - Country:US
Practice Address - Phone:858-679-6660
Practice Address - Fax:858-679-8580
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA322671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000773486OtherUC PROVIDER NUMBER
CAB32267-01Medicare ID - Type UnspecifiedPROVIDER NUMBER