Provider Demographics
NPI:1821603218
Name:BAKER, KATIE LANDIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LANDIS
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 1:2563 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1618
Mailing Address - Country:US
Mailing Address - Phone:252-237-4191
Mailing Address - Fax:
Practice Address - Street 1:2563 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1618
Practice Address - Country:US
Practice Address - Phone:252-237-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice