Provider Demographics
NPI:1518204254
Name:BAKER ORTHODONTICS
Entity Type:Organization
Organization Name:BAKER ORTHODONTICS
Other - Org Name:ORTHODONTIC GROUP OF THE FINGER LAKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-272-9321
Mailing Address - Street 1:412 N TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4256
Mailing Address - Country:US
Mailing Address - Phone:607-272-3921
Mailing Address - Fax:607-272-7150
Practice Address - Street 1:412 N TIOGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4256
Practice Address - Country:US
Practice Address - Phone:607-272-3921
Practice Address - Fax:607-272-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04149011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty