Provider Demographics
NPI:1821293911
Name:BAKER, ELIZABETH LEAVESLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEAVESLEY
Last Name:BAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4266
Mailing Address - Country:US
Mailing Address - Phone:302-658-9511
Mailing Address - Fax:
Practice Address - Street 1:1304 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4266
Practice Address - Country:US
Practice Address - Phone:302-658-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist