Provider Demographics
NPI:1558317974
Name:BAKER, RICHARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3017
Mailing Address - Country:US
Mailing Address - Phone:248-623-7722
Mailing Address - Fax:248-623-9816
Practice Address - Street 1:3485 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3017
Practice Address - Country:US
Practice Address - Phone:248-623-7722
Practice Address - Fax:248-623-9816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI115241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice