Provider Demographics
NPI:1467411033
Name:BAKER, DARREL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:A
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 1:2800 PIERCE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3407
Mailing Address - Country:US
Mailing Address - Phone:712-255-0107
Mailing Address - Fax:712-255-0145
Practice Address - Street 1:2800 PIERCE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3407
Practice Address - Country:US
Practice Address - Phone:712-255-0107
Practice Address - Fax:712-255-0145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA60491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0045112Medicaid
SD7850270Medicaid
IA25225OtherBCBS
NE91201365400Medicaid
T01434Medicare UPIN
18401Medicare ID - Type Unspecified
SD7850270Medicaid