Provider Demographics
NPI:1659452530
Name:BAKER, KEVIN LEIGH (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEIGH
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:642 VAL VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3659
Mailing Address - Country:US
Mailing Address - Phone:307-672-6917
Mailing Address - Fax:307-672-6633
Practice Address - Street 1:642 VAL VISTA ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3659
Practice Address - Country:US
Practice Address - Phone:307-672-6917
Practice Address - Fax:307-672-6633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY7671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics