Provider Demographics
NPI:1407962947
Name:BAKER, ZITA KATRICE (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:ZITA
Middle Name:KATRICE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6356 HORNBUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7103
Mailing Address - Country:US
Mailing Address - Phone:910-868-2333
Mailing Address - Fax:910-864-5791
Practice Address - Street 1:4200 MORGANTON RD
Practice Address - Street 2:SUITE 304
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1564
Practice Address - Country:US
Practice Address - Phone:910-488-0175
Practice Address - Fax:910-864-5791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903748Medicaid
NC7950OtherLISCENCE #
NC1860266OtherUNITED CONCORDIA PROVIDER
NC1860266OtherUNITED CONCORDIA PROVIDER