Provider Demographics
NPI:1588832802
Name:BAKER JR, RAYMOND C (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:BAKER JR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:C
Other - Last Name:BAKER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS INC
Mailing Address - Street 1:1922 THOMSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-845-1121
Mailing Address - Fax:434-845-1096
Practice Address - Street 1:1922 THOMSON DRIVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-845-1121
Practice Address - Fax:434-845-1096
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010047671223G0001X
VA04380001051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
179327OtherANTHEM BCBS
9177705OtherDORAL
00882OtherUNITED CONCORDIA