Provider Demographics
NPI:1578783858
Name:BAKER, LILLIAN BARICEVIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:BARICEVIC
Last Name:BAKER
Suffix:
Gender:F
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:PO BOX 291
Mailing Address - Street 2:11 POTTERSVILLE ROAD
Mailing Address - City:POTTERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07979-0291
Mailing Address - Country:US
Mailing Address - Phone:908-439-3181
Mailing Address - Fax:908-439-3191
Practice Address - Street 1:11 POTTERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:POTTERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07979-0291
Practice Address - Country:US
Practice Address - Phone:908-439-3181
Practice Address - Fax:908-439-3191
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI203981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice