Provider Demographics
NPI:1437648276
Name:BAKER, KAYLA RENEE (RDH)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 BRYN MAWR DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1711
Mailing Address - Country:US
Mailing Address - Phone:505-977-9219
Mailing Address - Fax:
Practice Address - Street 1:1501 E RIVER RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7429
Practice Address - Country:US
Practice Address - Phone:505-864-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH4326124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist