Provider Demographics
NPI:1659819050
Name:MARK A BAKER PC
Entity Type:Organization
Organization Name:MARK A BAKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-0621
Mailing Address - Street 1:352 E RIVERSIDE DR
Mailing Address - Street 2:STE C1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6758
Mailing Address - Country:US
Mailing Address - Phone:435-628-0621
Mailing Address - Fax:
Practice Address - Street 1:352 E RIVERSIDE DR
Practice Address - Street 2:STE C1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6758
Practice Address - Country:US
Practice Address - Phone:435-628-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty