Provider Demographics
NPI:1598268849
Name:BAKER PEDIATRIC DENTAL CARE
Entity Type:Organization
Organization Name:BAKER PEDIATRIC DENTAL CARE
Other - Org Name:RYAN B BAKER DMD APDC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-405-8434
Mailing Address - Street 1:14591 NEWPORT AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6026
Mailing Address - Country:US
Mailing Address - Phone:951-672-1666
Mailing Address - Fax:855-895-3627
Practice Address - Street 1:27180 NEWPORT RD STE 3
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7389
Practice Address - Country:US
Practice Address - Phone:951-672-1666
Practice Address - Fax:855-895-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598268849Medicaid