Provider Demographics
NPI:1477672012
Name:BAKER, DAVID L (DDS, PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 COIT RD STE 290
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5029
Mailing Address - Country:US
Mailing Address - Phone:972-612-3920
Mailing Address - Fax:972-612-3544
Practice Address - Street 1:1708 COIT RD STE 290
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5029
Practice Address - Country:US
Practice Address - Phone:972-612-3920
Practice Address - Fax:972-612-3544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice