Provider Demographics
NPI:1659572584
Name:BAKER, EVAN CLAUD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:CLAUD
Last Name:BAKER
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 1:846 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-2730
Mailing Address - Country:US
Mailing Address - Phone:909-984-6868
Mailing Address - Fax:909-988-5323
Practice Address - Street 1:846 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2730
Practice Address - Country:US
Practice Address - Phone:909-984-6868
Practice Address - Fax:909-988-5323
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist