Provider Demographics
NPI:1518056662
Name:TONYA WOODALL BAKER, D.M.D., INC.
Entity Type:Organization
Organization Name:TONYA WOODALL BAKER, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:WOODALL
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-602-0540
Mailing Address - Street 1:190 CURTIS PKWY NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2062
Mailing Address - Country:US
Mailing Address - Phone:706-602-0540
Mailing Address - Fax:706-602-2879
Practice Address - Street 1:190 CURTIS PKWY NE
Practice Address - Street 2:SUITE A
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2062
Practice Address - Country:US
Practice Address - Phone:706-602-0540
Practice Address - Fax:706-602-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty