Provider Demographics
NPI:1770641508
Name:BAKER, ROBERT ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
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 1:3210 STONE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-2966
Mailing Address - Country:US
Mailing Address - Phone:903-984-2047
Mailing Address - Fax:903-983-2980
Practice Address - Street 1:3210 STONE RD
Practice Address - Street 2:SUITE B
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-2966
Practice Address - Country:US
Practice Address - Phone:903-984-2047
Practice Address - Fax:903-983-2980
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice