Provider Demographics
NPI:1770671463
Name:BAKER, LIONEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:
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 1:2019 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8913
Mailing Address - Country:US
Mailing Address - Phone:706-324-7249
Mailing Address - Fax:706-324-7290
Practice Address - Street 1:2019 7TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8913
Practice Address - Country:US
Practice Address - Phone:706-324-7249
Practice Address - Fax:706-324-7290
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA819740OtherCOMMERCIAL INSURANCE