Provider Demographics
NPI:1497185557
Name:DR. BRUCE B. BAKER DDS AND DR. ROBERT A MCDAVID DDS LLC
Entity Type:Organization
Organization Name:DR. BRUCE B. BAKER DDS AND DR. ROBERT A MCDAVID DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BOUNDS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-687-6105
Mailing Address - Street 1:611 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2525
Mailing Address - Country:US
Mailing Address - Phone:740-687-6105
Mailing Address - Fax:740-687-0399
Practice Address - Street 1:611 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2525
Practice Address - Country:US
Practice Address - Phone:740-687-6105
Practice Address - Fax:740-687-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty