Provider Demographics
NPI:1457473803
Name:BAKER, JASON EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
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 1:77 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-5822
Mailing Address - Country:US
Mailing Address - Phone:850-650-2070
Mailing Address - Fax:850-650-2073
Practice Address - Street 1:77 S SHORE DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-5822
Practice Address - Country:US
Practice Address - Phone:850-650-2070
Practice Address - Fax:850-650-2073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL177841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice