Provider Demographics
NPI:1558776971
Name:BAKER, SHIRLEY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 CAMINO DE LA PLZ STE 26
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3071
Mailing Address - Country:US
Mailing Address - Phone:619-971-2297
Mailing Address - Fax:
Practice Address - Street 1:DR. ATL 2084 STE 308
Practice Address - Street 2:ZONA RIO
Practice Address - City:TIJUANA
Practice Address - State:BC
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:619-270-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCEDULA 4680157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist