Provider Demographics
NPI:1417068743
Name:BAKER, DEBRA LOUISE (DDS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LOUISE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LOUISE
Other - Last Name:PARACHOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1895 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7976
Mailing Address - Country:US
Mailing Address - Phone:916-773-4553
Mailing Address - Fax:916-773-4618
Practice Address - Street 1:1895 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7976
Practice Address - Country:US
Practice Address - Phone:916-773-4553
Practice Address - Fax:916-773-4618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1529151OtherUNITED CONCORDIA PIN