Provider Demographics
NPI:1417132838
Name:BAKER, ALLEN RONALD (DMD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:RONALD
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 TRUMAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340
Mailing Address - Country:US
Mailing Address - Phone:818-365-7107
Mailing Address - Fax:818-365-0092
Practice Address - Street 1:1240 TRUMAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340
Practice Address - Country:US
Practice Address - Phone:818-365-7107
Practice Address - Fax:818-365-0092
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist