Provider Demographics
NPI:1508992520
Name:BAKER, MARK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 REED RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2058
Mailing Address - Country:US
Mailing Address - Phone:864-225-3141
Mailing Address - Fax:864-225-3142
Practice Address - Street 1:514 REED RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2058
Practice Address - Country:US
Practice Address - Phone:864-225-3141
Practice Address - Fax:864-225-3142
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2908-03791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics