Provider Demographics
NPI:1629314000
Name:BAPTIST, DAVID B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:BAPTIST
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 1:5850 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2220
Mailing Address - Country:US
Mailing Address - Phone:773-233-1249
Mailing Address - Fax:
Practice Address - Street 1:3838 W 111TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-4095
Practice Address - Country:US
Practice Address - Phone:773-233-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.015601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.015601OtherSTATE OF IL