Provider Demographics
NPI:1528212115
Name:BAKER, DAVID MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
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 1:14 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-8509
Mailing Address - Country:US
Mailing Address - Phone:617-218-7265
Mailing Address - Fax:
Practice Address - Street 1:1692B HOSPITAL DR STE 201B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4825
Practice Address - Country:US
Practice Address - Phone:505-988-1187
Practice Address - Fax:505-988-2186
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22189122300000X
NMDD32841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist