Provider Demographics
NPI:1376657619
Name:BAKER, DORSEY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORSEY
Middle Name:W
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N. 59 AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-942-0623
Mailing Address - Fax:602-942-2409
Practice Address - Street 1:18275 N. 59 AVE
Practice Address - Street 2:STE 150
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-942-0623
Practice Address - Fax:602-942-2409
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3760122300000X, 1223G0001X
AZAZ 37601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ3760OtherAZ DENTAL BOARD