Provider Demographics
NPI:1568613610
Name:BAKER, TYLER FREDERIC (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:FREDERIC
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 1:955 BOARDWALK SUITE 302
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078
Mailing Address - Country:US
Mailing Address - Phone:760-510-1133
Mailing Address - Fax:760-510-1132
Practice Address - Street 1:365 S RANCHO SANTA FE RD
Practice Address - Street 2:201
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2338
Practice Address - Country:US
Practice Address - Phone:760-510-1133
Practice Address - Fax:760-510-1132
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics